TREATISE 



ON 



GONORRHOEA VIRULENTA, 



AND 



LUES VENEREA. 



BY BENJAMIN BELL, 

MEMBER OP THE ROYAL COLLEGE OF SURGEONS OF IRELAND AND EDINBURGH, 

ONE OF THE SURGEONS TO THE ROYAL INFIRMARY, AND FELLOW OF 

THE ROYAL SOCIETY OF EDINBURGH. 



WITH NOTES, 

ADAPTED TO THE PRESENT STATE OF PRACTICE IN THOSE DlfiEASE^.i 



TWO VOLUMES /JV OAT 



VOL. I, 



ALBANY s 
PUBLISHED BY E. F. BACKUS, 

NO. 65, STATE-STREET, 

3. & E. Hosford—Printers-Al&ffnvs 

1814. 






4* 



District of New-York, ss. 

BE IT REMEMBERED, tliat on the tenth day of October, m the 

thirty -ninth year of the independence of the United SJates of Ameri- 

L. S. ca, E. F. Backus, of the said District, has deposited in this office 

the title of a Book, the right whereof he claims as Proprietor, in the 

words following-, to wit ; 

c A Treatise on Gonorrhoea Virulenta, and Lues Venerea. By Benjamin Bell, 
Member of the Royal College of Surgeons of Ireland and Edinburgh, one of 
the Surgeons to the Royal Infirmary, and Fellow of the Royal Society of Edin- 
burgh. With Notes, adapted to the present state of practice in those diseases. 
Two volumes in ones. 

In conformity to the Act of the Congress of the United States, entitled " An 
Act for the encouragement of Learnmg, by securing the copies of Maps, Charts 
and Books to the authors and proprietors of such copies, during the time 
therein mentioned." And also to an Act, entitled " an Act. supplementary to 
an Act, entitled an Act for the encouragement of Learning-, by securing the 
copies of Maps, Charts, and Books to the authors and proprietors of such 
eopxes, during the times therein mentioned, and extending the benefits thereof 
to the arts of designing, engraving and etching historical and other prints." 

THERON RUDD, 
Clerk of the Southern District of JVIew-Tork. 



ERRATA. 

Volume 1st. 
Page 89, line 17, for by, read but. 
Page 207, line 21, for as, read is. 

Volume 2nd. 
Page 162, line 42, for oszena, read eczema. 
Page 193, line 19, for breat read breast. 

Page 222, line 46, in a few copies for mtermscence read intumescence 
Page 284, line 9, for balanci, reaci jbalani. 



ADVERTISEMENT TO THE PRESENT EDITION. 

The Editors of the present edition of Bell on 1he 
Venereal, have endeavoured to render that work more 
valuable, by adding to it the improvements in practice 
as well as the investigations on the nature of the disease, 
which have been offered since the period at which the 
Author wrote. This information they have condensed in 
as small a space as possible, and adhering strictly to the 
principle of leaving the original text untouched, have 
presented it in the form of notes to the several sections. 
In preparing these, a free use has been made of every 
late writer within their reach, whose opinions or expe- 
rience have appeared to deserve attention; and should 
their additions comprise to the satisfaction of the med- 
ical reader, an analysis or notice of the above produc- 
tions, their wishes will be fully gratified. 

Albany, Oct. 8th, 1814. 



TO 

DOCTOR WILLIAM SANDERS, 

6ENI0R PHYSICIAN TO GUT'S HOSPITAL, 

jRELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON, 

AND 

OF THE ROYAL SOCIETY OF EDINBURGH, 

These Volumes are respectfully dedicated, as a 
small testimony of regard, and public acknowledg- 
ment, for the advantages which have been derived 
from his various exertions to promote the extension 
and general utility of medical science, by 

His obedient, 

And very humble Servant, 

BENJn. bell. 

EDnsrBTmsH, V 
^St Nov. 1792. 5 



PREFACE 



AS many of the symptoms of Gonorrhoea and Lues 
Venerea become frequent objects of the surgeon's at- 
tention, I at one time meant to have introduced a trea- 
tise on these diseases in the System of Surgery pub- 
lished some years ago, but I was prevented from doing 
so, by different publications upon the same subject be- 
ing announced about the same period. 

As these works have since made their appearance? 
and, as some of them have been very favourably re- 
ceived, it may be imagined, that farther writings upon 
this subject can scarcely at present be required. It 
must indeed be admitted that many valuable publica- 
tions have come forth within these few years upon this 
branch of the profession ; particularly one by Mr. 
John Hunter of London, intitled, A Treatise on the 
Venereal Disease ; and another intitled, Practical 
Observations on Venereal Complaints, by Doctor 
Swediaur. But although much information may be 
obtained from both of these works, as well as from 
some other late publications upon this subject, there 
is still much left for others to elucidate. Such is the 
effect of experience and observation, that farther ad- 
vantages are daily accruing from the labours of indi- 
viduals in the treatment of this as well as of almost 
every other disease ; and as this I hope will in some 
degree appear from the present publication, so I shall 
still expect to find that the future endeavours of others 
will prove yet more successful. 

Among other points which I have more particularly 
attempted to elucidate, the treatment of Gonorrhoea 
by injections, and the quantity of mercury to be ex- 
hibited in Lues Venerea, are, perhaps, the most im- 
portant ; and I flatter myself that I have given views 
concerning them, which, in practice will be found to 
merit attention. The cure of Gonorrhoea by injec- 
tions is, no doubt very universally practised ; but while 
in a great proportion of cases it proves successful, in 



till PREFACE. 

others it fails entirely : The cause of this, so far as I 
know, has never hitherto been explained. Whether I 
may have conveyed an adequate idea of my opinion 
upon this point I cannot positively say ; but the obser- 
vations upon which it is founded are such, that all who 
pay attention to the subject may be enabled readily to 
ascertain such cases as will yield to injections, as well 
as those in which no advantage is to be expected from 
them. 

The opinion which I have ventured to support, of 
the difference between the matter of Gonorrhoea, and 
that of Lues Venerea, will no doubt be censured by 
many. They ought, however, to recollect, in matters 
of opinion, which cannot be proved by demonstration, 
that some unceriainty must always take place ; and be- 
fore censuring with severity the opinions which others 
may suggest, they should consider whether their own 
may not be equally liable to objection. To me it ap- 
pears that the reasons which! have adduced in support 
of my opinion are very conclusive, but I shall make 
full acknowledgement of my error, if sufficient reasons 
shall ever be given to show that it is ill-founded. In 
the mean time, it will be perceived, that the theory 
which I have adopted does not lead to any deviation 
from the practice which now generally prevails upon 
this point, while it serves to explain more clearly than 
the opinion which has commonly prevailed, several of 
the phenomena of the two diseases, as well as the 
cause of different remedies being necessary for each 
of them. 

I do not expect that practitioners of experience and 
observation will derive much information from this 
publication, but I am hopeful that beginners will de- 
rive some advantage from it ; for it has been equally 
my desire to exhibit a correct view of the different 
symptoms of which I treat, and to point out the method 
of cure in a manner that will be clear and intelligible. 
Where theory isever admitted, it is chiefly with a view 
to explain, upon rational principles, such points as the 
ingenuity of some speculative writers have tended to 
render intricate. 



CONTENTS. 

VOLUME I. 

CHAP. I. 

Consideration of the Question, Whether Gonorrhoea and Lues 
Venerea originate from the same Contagion, - Page 1? 

CHAP. II. 

Of Gonorrhoea Virulenta, 

SECT. I. 

General Observations on the Symptoms, Causes, and Seat of 
Gonorrhoea Virulenta, 37 

SECT. II. 

Of the Prognosis in Gonorrhoea Virulenta, 48 

SECT. III. 
General Observations on the Cure of Gonorrhoea, ■> - 50 

SECT. IV. 
Of the First Stage of Gonorrhoea, 57 

SECT. V. 
Of the Second Stage of Gonorrhoea, - - 70 

SECT. VI. 
Of the Third Stage of Gonorrhoea, - - * - 77 

SECT. VII. 
Of the Fourth Stage of Gonorrhoea, 85 

SECT. VIIL 
Of Chordee, - - - - 9} 

SECT. IX. 
Of Haemorrhages from the Urethra, 94. 

SLCT. X. 
Of Gonorrhoea in Women, - * ' - - - 95 



X CONTENTS. 

SECT. XL 

Recapitulation, ---„-.. Page 10 1 

CHAP. III. 

Of the Consequences of Gonorrhoea Virulenta. 

SECT. I. 

General Remarks on the Consequences of Gonorrhoea, - 104 

SECT. II. 
Of Gleets, - - - - - . - - - 105 

SECT. III. 
Of Impotency from Seminal Weakness, - 136 

SECT. IV. 

Of Obstructions in the Urethra from Gonorrhoea Virulenta 134 

§ I. Of Tumours in the Urethra and contiguous parts, - 135 
§ Z. Of Spasmodic Obstructions in the Urethra, - - 137 
§ 3. Oi Caruncles in the Urethra, - - - 144 

§ 4. Of Obstructions in the Urethra from Strictures, proper- 
ly so called ; of Bougies, and Fistmse in Perineo, - - 146 

SECT. V. 

Of Deranged Sensations in the Bladder, Urethra, and contigu- 
ous parts, --------- igt 

SECT. VI 

Of Swellings of the Testicles, 194 

SECT. VII. 

Of Swellings of the Spermatic Cord, <- 208 

SECT. VIII. 
Of Swellings of the Lymphatic Vessels of the Penis, - 210 

SECT. IX. 
Of Swellings of the Glands of the Groin, - - . - 214 

SECT. X. 
Of Excoriations of the Glans and Prepuce, * - 217" 



CONTENTS. Xi 

SECT. XI. 

Of Excoriations in the Parts of Generation in Women, Page 252 

SECT. XII. 
Of Phymosis and Paraphymosis, - - - - 223 

SECT. XIII. 
Of Warts on the Glans and Prepuce, and Labia Pudendi, - 23! 

SECT. XIV. 
Of Gonorrhoea Simplex, - 236 

VOLUME II. 

CHAP. IV. 

On Lues Venerea. 

SECT. I. 



General Observations on Lues Venerea, 

SECT. IL 



Symptoms of Lues Venerea, - - - - 12 

General Observations, ------ ib. 

Of Chancres, ------- ib. 

Of Buboes, 20 

Of the Venereal Sore Throat, 37 

Of Venereal S >res in the Nose and Mouth, 42 

Of Venereal Blotches, ------ 50 

Of Venereal Ulcers, 55 

Of Nodes, and other Swellings of the Periosteum, 

Bones, and Tendons, 62 

Of Venereal Excrescences about the Anus, - - 70 

Of the Venereal Swelling of the Testes, - - 72 

Of Alopecia, 75 

Of Blindness, as a Symptom of Lues Venerea, - 77 

■ Of Deafness, 80 

. Of Anomalous Symptoms, 81 

SECT. III. 



Of the 


§ 1. 


§ 2 


§ 3. 


§ 4. 


§5. 


§ 6. 


§7. 


§8. 


§9. 


§ 10 


§ 11 



§ 12. 
§ 13. 
§ 14 



Of the Venereal Virus. 



86 



Xll CONTENTS; 

SECT. IV. 

Of the Remedies used in Lues Venerea, * - - Page 0g 

§ 1. General Observations, ib„ 

§ 2. Of Mercury, - ~- 99 

1. Generai Observations upon Mercury, - - - ib. 

2 Of the Effects of Mercury upon the Human Body. - 100 

3. Of the Operation of Mercury in the Cure of Lues Venerea, 102 

4. Of the Preparations of Mercury, - 130 

5. Of the different Methods of exhibiting Mercury, - ' 137 

6. Of the Duration of a Mercurial Course, and the Quantity 

of Mercury to be exhibited, ----- 152 

7. Of the Regimen to be observed during a Course of Mer- 
cury, - - - - - - - - -167 

8. Of Profuse Salivation und some other Effects of Mercury, 169 

9. Does Mercury ever faii in the Cure of Lues Venerea ? 188 

§ 3. Of Guiacum, - - 192 

§ 4 Of Sarsaparilla, 196 

§ 5. QfMezereon, 198 

§ 6. Of Opium, ....... 201 

SECT. V. 

Of the Cure of Lues Venerea, - 208 

§ 1. Of the Cure of Chancres, ib. 

§ 2. Of the Cure of Buboes, 223 

§ 3. Of the Cure of Venereal Ulcers, - 236 

§ 4. Of the Cure of Venereal Blotches, - - - 243 

§ 5. Of the Cure of Nodes, Swellings of the Periosteum, he. 244 
§ 6 Of the Cure of Venereal Excrescences about the Anus, 247 
§ 7. Of the Cure of the Venereal Swelled Testicle, - 248 

§ 8. Of the Treatment of Alopecia, Venereal Blindness and 

Deafness 250 

§ 9. Of the Cure of some Anomalous Symptoms of Lues 

Venerea, - 254 

SECT. VI. 

Of Lues Venerea in Infants, ---*-- 257 

SECT. VII. 

Of iome Peculiarities of Form under which Lues Venerea has 

appeared in Scotland and Canada, - 268 

SECT. VIII. 

Of Prophylactics, -* - - - 282 

SECT. IX. 

Of Lues Venerea as inducing other Diseases, - - - 284 
Appendix, - - - - - - - «■ -313 



A 

Treatise 

ON 

GONORRHOEA VIRULENTA, 

AND 

LUES VENEREA. 

CHAPTER I. 

Consideration of the Question, whether Gonorrhea and 
Lues Venerea originate from the same Contagion. 

AN opinion has been generally received amongst 
practitioners, that Gonorrhoea Virulenta and 
Lues Venerea are of the same nature; that they origi- 
nate from the same contagion ; and are only distin- 
guished by the circumstance of Gonorrhoea being a lo- 
cal disease of the urethra, while the other is a general 
affection of the system. But, as there is cause to ima- 
gine that these diseases arise from different specific 
contagions, and as the establishing of one or other of 
these opinions must influence the conduct of the cure, 
it becomes a matter of importance to institute an en- 
quiry into this part of our subject. 

Both diseases are contracted in a similar way ; both, 
in the first instance, affect the genital organs ; and 
they occasionally appear at the same time in the same 
patient : hence it has been concluded that they have 
a common origin, and one method of cure has been 
supposed applicable to either. 

The refusal of some patients to submit to the dis- 
tress and inconveniency, the frequent result of a pro- 
tracted mercurial course, and who nevertheless reco- 
vered from the usual symptoms of Gonorrhoea; first 

3 



18 ON GONORRHOEA VIRULENTA, Ol. I. 

suggested a doubt of the two diseases being produced 
by the same contagion. It is well known that Lues 
Venerea can be certainly cured by mercury only ; 
and the opinion respecting the existence of a specific 
contagion of Gonorrhoea, arising from this obvious and 
marked difference in the method of cure, appears to 
be fixed and established by the following facts : The 
symptoms and consequences of Gonorrhoea are perfect- 
ly different from those which take place in Lues Ve- 
nerea. Both diseases have appeared, at different pe- 
riods in the same countries; and, in some instances, 
they have remained distinct and uncombined for a 
great length of time. 

That the symptoms of the two diseases are differ- 
ent, is universally known. A particular detail of such 
as are peculiar to each, will be given in the ensuing 
chapters. At present, it is only necessary to observe, 
thai Gonorrhoea consists of a discharge of puriform mat- 
ter from the urethra ; which, even by those who sup- 
port the contrary opinion, is now admitted to be in 
almost every instance, a local affection, and that it \e- 
ry rarely contaminates the general habit of body : 
while Lues Venerea is a disease of the constitution, ari- 
sing from the absorption of venereal virus from any 
part of the surface of the body, but most frequently 
from the genitals ; by which are produced buboes, ul- 
cers in various parts, particularly in the nose and 
throat, pains and swellings in the bones, with a vari- 
ety of other symptoms which it is not at present ne- 
cessary to mention. 

The first appearance of the Lues Venerea is, for 
the most prat, in the form of a chancre or small ulcer, 
in some part of the penis. It is universally admitted* 
that even the slightest affection of this nature is apt to 
produce the pox, or a general affection of the system - r 
insomuch, that no practitioner of experience will trust 
the cure of this symptom to local remedies. If the 
sore be left to itself, it almost always becomes worse. 
The matter which it affords is taken up by the absorb- 
ents ; and buboes, with the other symptoms enume- 



€h. I. AND LUES VENEREA. 19 

rated above, very certainly ensue. These are almost 
the universal consequences of a sore produced by the 
venereal virus; but they also occur frequently where 
the skin remains sound and entire ; that is, absorption 
of the venereal poison often takes place where no ves- 
tige of ulceration is perceptible. This, indeed, is de- 
nied by many ; but I have met with various instances 
of it, and it will be admitted by every practitioner of 
experience. Now, this being established, in the ap- 
plication of the venereal virus to every other part of 
the body, if the matter of Gonorrhoea were of the 
same nature, why does it not, in almost every instance, 
enter the system, and produce pox ? So far as we 
know, the urethra is as plentifully supplied with ab- 
sorbents as other parts of the body ; the same kind of 
matter, when applied to them here, ought therefore to 
be productive of similar effects : and hence Lues Ven- 
erea ought frequently, perhaps in every instance, to be 
the consequence of Gonorrhoea, were the matter by 
which the two diseases are produced, the same. 

As this is a strong argument in favour of the two dis- 
eases proceeding from different kinds of contagion, 
much ingenuity has been exerted by those who support 
the* contrary opinion, in endeavouring to account for it. 

In the first place, it has been said, that Gonorrhoea 
sometimes terminates in pox, and, therefore, that this 
of itself is a sufficient proof of the two affections be- 
ing of the same nature. 

Were it certain that this ever happened, no farther 
evidence would be required, as a few well-marked in- 
stances would be conclusive; but every unprejudiced 
practitioner will admit, that no sufficient proofs of it 
have ever occured. 

In order to support this opinion, data must be re* 
ceived, which we know to be inadmissible. We must 
admit, that a person with chancres only, communi- 
cates to another, not only every symptom of pox, but 
of Gonorrhoea, and that another with Gonorrhoea on- 
ly gives to all with whom he may have connection, 
chancres with their various consequences. This ought, 
indeed, to be a very common occurrence ; insomuch 



20 ON GONORRHOEA VIRULENTA, Cb. I. 

that every practitioner should be able to decide upon 
it with certainty, if this opinion was well founded: 
Instead of which, it will be admitted by all, that the 
one disease being produced by the other is even, in 
appearance, a very rare occurrence, I have paid much 
attention to the point in question ; and, in almost eve- 
ry instance, a few cases indeed only excepted, and 
where the most particular enquiries even were made, 
it has happened, that a person infected with Gonor- 
rhoea has received it from another evidently labour- 
ing ^hder that disease, and that chancres have been 
communicated by such as were distressed with chan- 
cres only. 

This, I am convinced, will be very commonly found 
to be clearly the case ; so that a few instances, bearing 
some appearances of the contrary, are much more rea- 
dily explained on the- idea of the two diseases being 
produced by different kinds of contagion ; and this 
may also be said of the few solitary cases that may be 
met with, of chancre being supposed to terminate in 
Gonorrhoea, and Gonorrhoea in chancre,- and other 
symptoms of pox. We can more easily eoriceiye that 
the same person should, in some instances, receive, and 
therefore be able to communicate, both kinds of con- 
tagion, than that the incident we are considering 
should be so seldom met with, were the opinion well 
founded, of the two diseases being originally of the 
^ame nature. 

However ill founded an established opinion may be, 
Jf it has received the sanction of being generally a- 
dopted, we know how difficult it is to overturn it. 
There are few who enter so minutely into the consi- 
deration of such points as to be able to decide upon 
them ; and of those who do, there are very few who 
will fake the trouble of engaging in such discussions 
ps are necessary for the conviction of others. This 
may be considered as the chief cause of the point in 
question remaining so long in obscurity, as well as of 
the explanation hitherto usually given, of various cir- 
cumstances in Gonorrhoea and Lues Venerea having 
fceen uniformly made to support it f It will also serve to 



Ch. I. AND LUES VENEREA. 21 

account for circumstances being held forth as matter 
of fact, which, on enquiry, are perceived to be ill 
founded ; for, when once an opinion is admitted, we 
are apt to give such an explanation of whatever may 
seem to relate to it, as can in any way tend to sup- 
port it. 

Thus, although few in the present age will assert 
that Gonorrhoea often terminates in Lues Venerea, yet 
by many we are told, that it is very apt to do so when 
it is improperly treated. Whatever puts a sudden stop 
to a severe or copious discharge from the urethra is 
by many supposed to do harm. Hence all who con- 
demn the use of injections in Gonorrhoea affirm, that 
they often convert a simple clap into a pox, by throw- 
ing into the blood what otherwise would have been 
carried off. This, however, is by no means support- 
ed by experience. A stimulating injection will no 
doubt excite pain and inflammation in the urethra ; 
and this, in some instances, will be productive of swel- 
led testes, and perhaps of sympathetic swellings in the 
glands of the groin ; but I have not known a single in- 
stance of pox induced in this manner : and as I have 
long been in the daily use of injections, many cases of 
it must have occurred, if the idea I have just stated 
were well founded. Till of late, indeed, a patient who 
was so unfortunate as to havea clap suddenly stopped, 
;^was so certainly considered as poxed,>that he was im= 
^fffe^iately put* under a very complete coiirstTof mer- 
cW^£?^%McJ3 he was made to undergo a* v^Ty"* (fnne-* 
cessary ^^disVr^fttJ^confinement. 

Although this practice, however, is no*w very "com- 
monly exploded, yet the^are some who still adhere 
to it. I was called, in April 1784, to visit a gentleman 
who, in a Gonorrhoea attended with a good deal of in- 
flammation* had been so foolish as to live freely, and 
to ride much on horseback. This, with the unguarded 
use of a very stimulating injection, put a sudden stop 
to the discharge ; and at the same time it excited a 
very considerable degree of pain and inflammation 
along all the posterior part of the urethra, towards the 



22 ON GONORRHOEA VIRULENT A, Oil. I. 

prostrate gland and neck of the bladder, attended with 
a painful and frequent desire to make water. 

On the idea of these being symptoms of pox, he 
was immediately put under a course of mercury ; and, 
when . I first saw him, he had been using it for the 
space of six weeks. The surgeon in attendance ac- 
knowledged that no advantage had been derived from 
it ; and the patient himself said that his distress was 
daily increasing. They were both, therefore, easily 
persuaded to lay the mercury aside ; and, by the re- 
peated application of leeches to the perineum, of fo- 
mentations, and opiates, to allay the pain, the inflam- 
mation soon began to subside ; and, in a short time, he 
was perfectly well. 

In December 1738, a young man called upon me, 
with a painful hard swelling in his groin, of an oblong 
form, nearly an inch in diameter, and reaching from 
the ring in the external oblique muscle down to the 
top of the testis. It appeared suddenly, about four 
months before, and seemed to be the consequence of a 
clap being too hastily stopped. He was at first attack- 
ed with a severe pain at the neck of the bladder, which 
stretched to the groin, and down to the testis of the 
same side. This, together with a constant and pain- 
ful inclination to void urine, rendered his life miser- 
able. Nor was his distress in any degree abated by a 
course of mercury which he was immediately put un- 
der. On the contrary, the swelling, which at first was 
not thicker than a common quill, was now very con- 
siderable. My idea of the swelling was, that at first 
it had been merely an inflammatory affection of the 
vas deferens, which by degrees had spread to the rest 
of the spermatic chord ; but, what was unusual, it had 
never affected either the testis or epididemis. As a 
considerable quantity of mercury had been taken, 
and as, instead of proving useful, it had rather appear- 
ed to do harm, the surgeon whom he employed was 
easily persuaded to trust the cure to other remedies. 
Local blood-letting with leeches was frequently re- 
peated, both in the perineum and groin. The parts 
were regularly fomented with a solution of saccharum 



Ch. I. AND LUES VENEREA. 23 

saturni. His bowels were kept easy with gentle lax- 
atives, and he was put upon a mild diet of milk and 
vegetables. In a few days the pain abated, and the 
tumour gradually lessened, till at last, in the course 
of five or six weeks, it was entirely gone. 

In the course of last winter, I attended two different 
patients, with alarming symptoms about the neck of 
the bladder, evidently induced by the improper man- 
agement of Gonorrhoea. The parts in both were not 
merely pained, but considerably swelled ; and, at 
the same time, almost a total suppression of urine took 
place. Although in both, the discharge from the ure- 
thra had been suddenly stopped, I did not advise mer- 
cury. The patients being both plethoric, were plen- 
tifully blooded, first at the arm, and afterwards repeat- 
edly with leeches in the perineum. This, with fomen- 
tations, and opiates to allay the violence of the pain, 
assisted by a cooling regimen and gentle relaxatives, 
very soon completed the cures. 

These instances are given out of a great number 
that might be adduced, merely to shew, that the symp- 
toms which supervene on the sudden stoppage of a clap, 
are local, and not connected with any affection of the 
constitution, which they necessarily would be, if they 
were of the same nature with Lues Venerea. 

It will perhaps be said, that although this may have 
happened in a few cases, yet that in others there has 
been cause to suspect, that Lues Venerea has been the 
consequence of a clap disappearing in this manner. In 
answer to this, it is sufficient for me to shew, that this 
is at least a rare occurrence, as I think I am intitled 
to do, from my never having met with an instance of 
it. It has been supposed, that the sudden check given 
to the discharge in cases of clap, must necessarily 
throw the matter into the blood, and that pox must 
accordingly ensue from it. Were the matter of the 
two diseases the same, this would happen in every in- 
stance ; so that, when we can show that it seldom hap- 
pens even in appearance, we are entitled, from this 
argument alone, to conclude, that they are produced 
by two different kinds of contagion ; and, where pox 



24 ON GONORRHOEA VIRULENTA, Ch. I. 

has appeared at the sudden termination of Gonorrhoea, 
that the two kinds of infection had either been com- 
municated together; or, what may more frequently 
perhaps be the case, the patient will be found to have 
received the pocky contagion by communication with 
a diseased woman at the very time he laboured under 
Gonorrhoea. I have already remarked, that Lues Ve- 
nerea is frequently produced by absorption while the 
skin remains entire, and where no chancre or excori- 
ation is perceptible. There is therefore much cause 
to imagine, that in long continued cases of Gonorrhoea, 
many may be infected with Lues Venerea by communi- 
cation with others labouring under it ; and as this may 
happen without any external mark of it taking place, 
it is not surprising that some fallacy should arise from 
this circumstance. 

The abettors of the opinion, that the matter of the 
two diseases are the same, admit that Gonorrhoea very 
seldom terminates in pox.* And they attempt to ac- 
count for this, that is, for the two diseases not being 
produced more frequently by the application of the 
same matter, by saying, that this depends upon the 
difference of parts to which the matter is applied. 

They divide the different surfaces of the body chief- 
ly into two kinds, what they term secreting surfaces 
and non-secreting surfaces. By the first they mean all 
the passages for extraneous matter, including also the 
ducts of glands, such as the mouth, nose, eyes, arms, 

* This is even granted by one who keenly supports the opposite doctrine in 
every other point. In speaking of Gonorrhoea and Chancre not terminating so 
frequently crs might be expected in the production of each other, he says, 
" Although it does not often happen, yet it sometimes does, at least there is 
" great reason to believe so. I have seen cases where a Gonorrhoea came on, and 
" m a few days after in some, in others as many weeks, a chancre has appear- 
*' ed ; and have also seen cases where a chancre has come first, and in the 
*' course of its cure a running and pain in making wate3? have succeeded." See 
a Treatise on the Venereal Disease, by John Hunter, page 16. 

This is what every practitioner has seen ; but by admitting so clearly that it • 
is a very rare occurrence, Mr. Hunter tends rather to strengthen the contrary 
opinion : for, were the two diseases produced by the same kind of matter, the 
one would clearly and necessarily often terminate in the other. In the few cases 
which Mr. Hunter, in the course of his extensive practice, has met with, there 
is more cause to imagine, either that the two diseases were communicated at 
once, or that the one was given while the patient laboured under the other, 
than that nature should deviate so much from her ordinary course as to pro- 
duce in them a few instances so very different from, what obviously happens 



Ch. I. AND LUES VENEREA. 25 

and urethra ; and by non-secreting surfaces, the exter- 
nal skin in general. To which they add a third kind 
of surface, leading from the one to the other, as the 
glans penis, prolabium of the mouth, the inside of the 
lips, and the female pudendum : which surfaces, par- 
taking of the properties of each of the others, but in a 
less degree, are capable of being affected in both ways, 
sometimes by being excited to secretion, and at other 
times to ulceration^. 

Upon this, their theory, or opinion of the point in 
question, is attempted to be established: When the 
contagion, either of Gonorrhoea or pox, and w- ich 
they consider to be the same, is applied to any part of 
the external skin, particularly to the glans penis 
where the skin is very thin, chancre or ulceration, 
they observe, will most readily ensue, as these are non 
secreting surfaces; while the same kind of matter ap- 
plied to the urethra must necessarily excite Gonor- 
rhoea, from this he;n^ a secreting surface, and therefore 
not so easily atiected with ulceration as with irritation ; 
by which an increased discharge, attended with some 
change in the mucus of the pait, must accordingly be 
produced. 

This idea, however, is more ingenious than solid. 
It might answer the purpose of giving a specious ap- 
pearance to an ill-founded opinion, but it will not stand 
the test of inquiry. 

In the first place, on the supposition of the matter 
of Gonorrhoea and Lues Venerea being the same, the 
latter ought to be a much more frequent occurrence 
than the former, from the greater ease with which 
the matter of infection must, in every instance, be 
applied to those parts on which it can produce chan- 
cres than to the urethra, where, instead of chancre 
or ulceration, it almost always excites Gonorrhoea. 
It is difficult to conceive how the matter by which 
the disease is communicated should find access to the 
urethra; while, on the contrary, all the external 

* Vide John Hunter on the Venereal Disease. 

4 



26 ON GONORRHOEA VIRULENTA, Cb. I. 

parts of the penis, particularly the glans, must be easi- 
ly and universally exposed to it : and yet Gonorrhoea 
is a much more frequent disease than pox. Cases of 
Gonorrhoea are in proportion to those of Chancre and 
Pox, so far as my observation goes, of about three to 
one; while it is obvious, that the very reverse should 
happen, if the two diseases were produced by the same 
kind of matter*. 

Again, were this the case, should we not find Go- 
norrhcea, in almost every instance, terminating in Pox, 
and Chancre in Gonorrhoea ; for every one knows, 
that in Gonorrhoea the matter is at all times passing 
from the urethra over the glans and prepuce, and in 
Chancre, that it is passing from the glans into the en- 
trance of the urethra. It happens indeed, in a few 
instances, (Mr. Hunter, we see, has met with some 
cases of it) that the one disease supervenes upon the 
other: but we have also seen that these are rare occur- 
rences; and where they have not been communicat- 
ed by subsequent connection with an infected person, 
that the two diseases have probably been given at one 
and the same time. It is no argument against this sug- 
gestion, to say, that instances have been met with of 
a Gonorrhoea appearing during the continuance of 
chancres of several weeks duration, and vice versa; 
for every practitioner must have met with instances 
of these diseases both appearing at the distance of two 
or three months from any exposure to infection. 

I have at this moment a gentleman under cure for 
a deep, foul chancre, altogether within the urethra. 
It was of several weeks duration before I saw it, and 
yet no Gonorrhoea took place. He is now getting well 
by a complete course of mercury, and repeated appli- 
cation of caustic. 

I have met with various cases of this, as every prac- 
titioner must have done ; and, so lately as the month 

* Mr.Hunter supposes, that the proportion which the cases of Gonorrh 02a bear to 
those of Chancre, is as four or five to one. Vide Treatise on the Venereal Dis- 
ease, p. 217. This is surely a weighty argument against the opinion he endea- 
vours to support, of Gonorrhoea and Chancre proceeding from the same con- 
tagion. 



Ch. I. AND LUES VEffEKEA. 27 

of April last, I was called to a gentleman with a pain- 
ful chancre on each side of the urethra. The sore 
extended about the eighth part of an inch up the pas- 
sage ; and the parts being much inflamed, I hesitated 
to apply caustic. This rendered the cure tedious, but 
still no Gonorrhoea took place. At last, after having 
taken a considerable quantity of mercury, and when 
the chancres were looking clean, and in a healing state, 
he was seized with all the symptoms of a severe clap, 
with heat in making water, chordee, and a plentiful 
discharge of a thin green matter. This, however, 
bore all the appearance of a recent infection. I at 
once said so to my patient; and he candidly acknowl- 
edged that he had imprudently exposed himself, by 
having connection with a girl of the town, three or 
four days previous to the accession of these symptoms. 

We may also remark, that the discharge from Go- 
norrhoea frequently becomes so acrid as to excoriate 
the glans and preputium, and even to excite a very 
plentiful formation of matter ; but every one knows 
that this is materially different from chancre. It is 
altogether different in appearance, and so materially 
different in its effects, that scarcely any practitioner 
of experience will trust the cure of chancre to any 
thing but mercury, while, in the other, mercury, I 
imagine, is very seldom employed. However exten- 
sive the excoriations may be, they are easily removed 
by local remedies; and I have never known an in- 
stance of pox succeeding to this kind of treatment. 
Nay, I have met with various instances of such affec- 
tions, where mercury had been given in considerable 
quantities with no advantage whatever, and where a 
cure was effected by the use of an astringent wash. 

About eighteen months ago, a gentleman came to 
town from a considerable distance, with an extensive 
excoriation over all the glans and preputium, attend- 
ed with a discharge of a large quantity of thin, offensive 
matter. The quantity of matter indeed was so con- 
siderable, that at first sight it appeared to be the dis- 
charge from a very inveterate recent case of Gonor- 
rhoea ; but, on farther examination, it was found to 



28 ON GONORRHOEA VIRULENTA, Ch. I. 

proceed entirely from the glans and prepuce, the clap 
by which it was produced being entirely gone. 

He lad taken mercury for the space of six weeks ; 
and the parts had been regularly bathed in milk and 
vater, but with no advantage. The discharge con- 
tinued as plentiful as ever, and the preputium was be- 
girt ing to acquire some degree of thickness, and to be 
difficult to retract. In the space of a week he wa« 
completely cured, merely by bathing the parts from 
time to time with brandy and water, and applying, 
during the night, a poultice strongly impregnated with 
saccl arum saturni. 

This, as well as a variety of similar affections, which, 
were it necessary, I might enumerate, clearly evince, 
not only that the matter of Gonorrhoea, when confined 
to the urethra, does not terminate in pox, but that it 
proves equally inoffensive to the constitution, where 
it is even so si arp and acrid as to excoriate the sur- 
rounding parts, i his points out a very marked dif- 
ference between the matter of the two diseases. Iri 
pox, even the slightest sore never fails to throw mat- 
ter into tie system, while the most extensive affections 
proceeding from Gonorrhoea are so seldom found to in- 
jure the constitution, thai I have never met with an 
instanee of it. 

By those who wish to support the opposite doctrine, 
it is said, t! at the matter of Gonorrhoea would more 
frequently terminate in pox, were it not for the mucus 
of the urethra with which it is blended, and by which 
they suppose it to be rendered not only milder in its 
nature, but not so apt to be taken up by the absorbents. 
Th;s, however, is n etely ideal ; and no proof can be 
( advanced in support of it. Besides, the force of the 
argument is entirely done away, when we see, from 
what has been observed above, that event where the 
matter of Gonorrhoea is more acrimonious than almost 
ever occurs in cases of Chancre, so as in some instances 
to produce very extensive excoriations, that still no 
affection of the constitution ensues from it. 

Nay, we see, even in such diseases as are found to 
proceed from what is termed a translation of the matter 



Cll. I. AND LUES VENEREA. 29 

of Gonorrhoea to other parts of the body, and which 
we suppose to happen through the medium of the cir- 
culation, that still no affection of the constitution pro- 
ceeds from them. This is particularly the case in such 
instances of ophthalmia as sometimes proceed from Go- 
norrhoea, and in which a considerable discharge takes 
place, of a puriform matter from the eye-lids, very 
similar to the matter of a recent c'lap. I have also met 
with instances, of patients labouring under Gonorrhoea 
being seized with a similar discharge from the mem- 
brane of the nose ; but in none of these have I ever 
known Lues Venerea ensue. A considerable number 
of examples might be adduced of each of these ; but 
the three following will be sufficient. 

In the year 1786, a young man applied to me, with a 
very troublesome and painful disease in both eyes. The 
eye-balls were not much inflamed outwardly ; but as 
lie experienced an intense degree of pain from the ad- 
mission of light, I concluded that the retina, or other 
deep-seated parts of the eye, were in a state of inflam- 
mation ; and the membrane of the eye-lids was not on- 
ly inflamed, but a constant and copious discharge took 
place from them, of a greenish yellow matter, bearing 
much the appearance of the matter of a recent clap. 

The account I received of his disease was this : That 
he had for eight or ten days laboured under Gonor- 
rhoea, the symptoms of which, how 7 ever, were not 
more severe than usual ; when, after being heated 
Avith drinking port w r ine, the discharge from the ure- 
thra, which had previously been copious, disappeared 
almost entirely. His eyes, almost immediately there- 
after, became painful; and, in less than twenty-four 
hours, the discharge of matter had taken place from 
the eye-lids. 

The disease was at first treated with blisters, slight 
evacuations of blood, and the usual applications of oint- 
ments and collyria. These not proving successful, a 
course of mercury was prescribed : but, although dif- 
ferent attempts were made with it, mischief always 
ensued from it. It did not lessen the discharge, while 
it obviously increased the inflammation, and rendered 



30 ON GONORRHOEA VIRULENTA, Ch. I. 

the eyes more irritable. I therefore advised this re- 
medy to be laid aside. A quantity of blood was taken 
from the temporal artery of one side ; such vessels as 
were turgid upon the eye-balls were divided ; scarifi- 
cations were made in the inflamed parts of the eye-lids ; 
poultices were applied over the eyes, in which opium 
and saccharum saturni were dissolved; and gentle lax- 
atives were prescribed. By these means the pain soon 
abated ; the inflammation and discharge of matter less- 
ened ; and, in the course of a fortnight, no symptom 
of the disease remained, but a degree of irritability on 
exposure to much light, with which both eyes con- 
tinued to be distressed for fjve or six months thereafter. 

In the course of the following year, on being attack- 
ed with Gonorrhoea, but of a more violent nature than 
the former, he was again seized, after exposure to 
much cold, and riding on horseback, to a similar af- 
fection of his eyes. In this instance also, blood-letting, 
and the other remedies formerly prescribed, proved 
successful ; and he has not, since that period, had any 
return of* the disease. 

About two years ago, I was desired to visit a patient, 
who, during confinement from a swelled testis induced 
by a Gonorrhoea, was suddenly seized with a profuse 
discharge of matter from one of his nostrils, very simi- 
lar to the running of the clap. The membrane of the 
nostril appeared tender, and somewhat inflamed ; but 
little or no pain occurred from it. The discharge from 
the urethra had diminished considerably previous to the 
testis becoming inflamed, and, on this taking place from 
the nose, it disappeared entirely. This suggested the 
propriety of attempting to excite a return of the dis- 
charge by the urethra ; but no advantage being derived 
from this, I advised the affection of the nose to be treat- 
ed with injections similar to what we use in cases of 
clap. An astringent solution was thrown up, some- 
times with a syringe, and at other times by inserting 
a bit of sponge immersed in it up the nostril ; and in 
the course of a few days the running ceased entirely. 

Since that period, the same patient has been twice af- 
fected in a similar manner, and the same kind of treat- 



Ql. I. AND LUES VENEREA 31 

ment proved equally successful. No mercury was 
given, and no symptom of pox has ever appeared. 

In the course of a few weeks after the recovery of 
this patient from the first attack of the disease, I was 
desired to see a friend of his, who for several years had 
been distressed with a similar discharge from both his 
nostrils. The running had occurred during the c6n- 
linuance of a clap ; and although it had frequently 
diminished in quantity, yet at all times it was so con- 
siderable as to be productive of much uneasiness. No 
ulceration appeared on the membrane of the nostrils, 
but it was of a deep red colour, and tender over its 
whole extent. A variety of remedies had been em- 
ployed ; and at last, after the disease had gone on for 
upwards of three years, although no other symptom 
appeared, he was advised to undergo a course of mer- 
cury. This was done in the most attentive manner ; 
but no advantage ensued from it. 

In this situation, I expected that the same plan of 
treatment which proved successful in the preceding 
case, and which had also done so in others, would 
likewise answer here. In this, however, I was disap- 
pointed ; for, although every variety of injection was 
used that I ever employed, yet no material advantage 
ensued from them. The running was sometimes in- 
deed lessened by them, but it always returned equally 
severe as before ; and although it has of late, even 
when no remedies were employed, become considera- 
bly less, it still continues in such quantities as to prove 
highly distressful. No other symptom of the disease, 
however, has ever occurred. 

As a farther proof of the difference of the contagions 
of Syphilis and Gonorrhoea, it may be remarked, that 
no state of pox has ever been known to induce Go- 
norrhoea, which surely would occasionally happen, if 
the two diseases were of the same nature. We may 
also remark, that, in numberless instances, people 
have been poxed by the matter of Syphilis being by 
accident applied to a cut or scratch, as often happens 
with surgeons in the dressing of chancres and buboes ; 
but no one ever heard of a pox being got in this man 



32 ON GONORRHOEA VIRULENTA, Ch. I. 

ner from the matter of Gonorrhoea. It has indeed been 
said, that chancres may be produced by insinuating 
the matter of Gonorrhoea beneath the skin. But ex- 
periments upon this subject are productive of such 
anxiety and distress, that they never have been, nor 
ever probably will be, repeated so frequently as the na- 
ture of it would require. Nothing, therefore, can be 
admitted from this argument ; for, in order to avoid 
fallacy, and to give support to the opinion, these ex- 
periments would not only require to be conducted 
with accuracy, but to be numerous, and to be repeated 
on a variety of patients under every possible variety 
of circumstances ; whereas we have heard of only a 
single experiment or two being made by any individu- 
al ; and even these seem to have been made under the 
management of such as were strongly and obviously 
biassed in favour of one side of the question. 

In opposition to these, too, I may mention, that, 
induced by some late publications upon this subject, 
two young gentlemen of this place have made some 
experiments upon themselves, with a view to ascertain 
the point in dispute ; but the result was materially 
different from what appears to have happened in the 
experiments to which I allude. By the introduction 
of the matter of chancres, as well as of buboes, into 
the urethra, some pain and irritation were excited, but 
no Gonorrhoea ensued ; and, by fretting the skin of 
the prepuce and glans with a lancet, and rubbing the 
parts with the matter of Gonorrhoea, slight sores were 
produced ; but they never assumed the appearance of 
chancres, and they healed easily without the use of 
mercury. — For the reasons mentioned above, however, 
we cannot place much dependence upon these or any 
other experiments that have yet been made upon this 
subject ; we must trust therefore to experience and ob- 
servation in the ordinary course of practice for means 
to ascertain it. 

The other fact on which the doctrine we attempt to 
establish rests, is, that Gonorrhoea and Syphilis have 
appeared at different times in the same countries, and in 



Cil. I, AND LUES TENEREA. ' 33 

some instances have remained distinct and uncombincd 
for a great length of time. 

If these two diseases were of the same nature, and 
proceeded from the same contagion, they ought to 
have appeared nearly at the same time in every coun- 
try to which the infection w r as- carried. This does 
not appear, however, from the history of the disease, 
to have been the case. Prom the earlier writers up- 
on this subject, it is evident, that the Lues Venerea 
"was known in Europe at least forty years before the 
Gonorrhoea Virulenta. Doctor Astruc, whose accu- 
racy and minute attention to this subject' has not been 
equalled by any one, asserts, that in his time Go- 
norrhoea had not been long known in China, although 
we know that the Lues Venerea had long prevailed 
in that country : and it would appear, notwithstand- 
ing any thing that has been said to the contrary, 
that the Lues Venerea was imported into the island of 
Otaheite a considerable time before Gonorrhoea. It 
seems to have been carried to that and other islands 
in the South Seas by the very first European naviga- 
tors who touched there, and to have remained distinct, 
without being connected with Gonorrhoea, for a very 
considerable time ; for when Captain Cook visited 
these islands in his second voyage, we have authority 
for saying, that Gonorrhoea had not then appeared in 
them. 

These historical facts all tend to prove, that w T here 
only one of these diseases has been imported to any 
particular district, it has always remained distinct, 
without producing the other ; and which we cannot, 
suppose w r ould have happened, if both were formed 
by the same contagion* And, in addition to these, I 
may add another, not less remarkable, the truth of 
which may be ascertained by all who incline to in- 
quire concerning it, as the scene of it lies in our own 
country. 

In various parts of the country of Scotland, parti- 
cularly in some parts of the Highlands ; in Galloway, 
and in Dumfries-shire ; the common people have, for 

5 



\ 



34 ON GONORRHOEA VIRULENT A, Ch. I. 



a great length of time, been afflicted with the Lues 
Venerea, under the denomination, as they term it, 
of Sibbens ; and which, from those distressed with it 
having no communication with those infected with 
Gonorrhoea, has still, retained its original, unmixed 
form, without a single instance, so far as I know, of 
Gonorrhoea, having been ever produced by it*. There 
is evidence, in some of these districts, of this disease 
having prevailed among them for upwards of seventy 
years : Nay, in some of them, it is said, from tradition, 
to have been left there by the soldiers of Oliver Crom- 
well, and to have been given, since that period, by one 
generation to another; and, although 3 have had op- 
portunities of seeing many hunched people labouring 
under it, with ulcers in the throat, nodes of the bones, 
fungous excrescences about the anus, blotches over 
the body, with almost every other symptom of Syphi- 
lis, yet not an instance has occurred to me, as I have 
observed above, nor have I heard of any, where Gon- 
orrhoea took place in it. Whether it is from those in- 
fected with it concealing it longer than usually happens 
in towns, or what may be the cause of it, I shall not 
at present pretend to determine; but certain it is that 
the symptoms produced by it are more inveterate than 
we usually find them to be in the ordinary form of 
this disease. They appear 'to be more particularly 
infectious; the slightest communication with those la- 
bouring under the disease being apt to produce it. 
The symptoms spread more rapidly, and a greater 
quantity of mercury is, for the most part, required 
to remove them; but still Gonorrhoea is never pro- 
duced in any stage of the disease. 

A disease very similar to this broke out among the 
country people of Canada, some years ago, owing, as 
is imagined, to communication with some of the sol- 

* This must have happened from the disease in these districts prevailing al- 
most entn-ely among poor country people, whose manners do not expose them 
to the hazard of being infected with Gonorrhoea! None, however, can escape the 
Sibbens who are much in company with those labouring* under it ; and so much 
are they convinced of its being the same disease with Lues Venerea, that even 
those who get it in the most innocent manner, are so much ashamed, that 
they never speak of it as long as it can possibly be kept secret, 



Ci). h AND LUES VENEREA. 35 

diet's quartered among them, who were infected with 
Lues Venerea. It is attended, a? is tne case with the 
Sibbens in Scotland, with all the symptoms of Syphilis 
in the most virulent form of that disease ; audit is so 
very infectious as to be communicated by eating or 
drinking out of the same vessel, or drying with the 
same cloth that has been used by those .labouring under 
it. It often enters the constitution by absorption from 
the surface, without any previous ulceration : in which 
case it afterwards breaks out in buboes, nodes, ulcers, 
and other symptoms of a confirmed Lues; but not an 
instance, I am informed, has happened, of Gonorrhoea 
being produced by it. 

This, as well as what has occurred in (he progress 
of Sibbens, is precisely what happened with the Lues 
Venerea when it first appeared in Europe, as w r ell as 
at a late period in the South Seas; and there cannot 
be a doubt of the same circumstances taking place 
wherever the Syphilis only is communicated. We 
have seen, in all these instances, that Gonorrhoea has 
never been produced by it, which surely could not 
have happened if the I wo diseases were of the same na- 
ture, and produced by the same contagion. They 
could never, in that case, have remained for anv length 
of time so distinct and precisely marked ; for the one 
must necessarily, in almost every instance, have soon 
been productive of the other. 

As a farther support of this opinion, I may add, that 
if the two diseases were of the same nature, and pro- 
duced by the same infection, the remedies proving 
useful in the one, might be expected to prove likevvise 
so in the other. Insiead of this, we find that those upon 
which we depend with most certainty in Gonorrhoea, 
have no effect whatever in the cure of Syphilis, whi*e 
mercury, which is the only remedy, as we have obser- 
ved above, upon which any dependence can be placed 
for the cure of Syphilis, does not, in Gonorrhoea, pro- 
duce any advantage. Nay, that in some cases, it evi- 
dently does harm. 

We also know, that Gonorrhoea will often termi- 
nate whether any remedy be employed or not, merely 



36 ON GONORRHOEA VIRULENTA, &C. Ctl. I. 

by moderate living, and keeping the parts regularly 
clean. The disease by this alone will, in most instan- 
ces, become gradually milder, till at last it will dis- 
appear entirely. No such thing, however happens in 
Lues Venerea. In this as we have already remarked, 
even the mildest symptom becomes daily worse, un- 
less mercury be employed ; nor will any practitioner 
of experience trust the cure even of the slightest chan- 
cre to any other remedy. 

Upon this evidence alone, of the method of cure of 
the two diseases being so essentially different, we might 
I think, conclude that they are different in their na- 
ture, and that they proceed from different contagions. 
Were they of the same nature, and proceeding from 
the same cause, it is not possible to conceive that any 
medicine would act as a certain cure for one and do 
barm in the other, and yet every practitioner will ad- 
mit that mercury, is the only remedy hitherto known, 
upon which we can depend for the cure of Lues Ve- 
nerea, while it evidently often does harm, as I have al- 
ready observed, in Gonorrhoea. 

If the subject now under discussion was merely of a 
speculative nature I should not have entered so mi- 
nutely into it, for in that case it would have been a 
matter of indifference both to practitioners and patients 
whether these diseases were of the same nature or not ; 
but, as the treatment of Gonorrhoea ought to depend 
much upon this circumstance, I judged it proper be- 
fore proceeding to treat of it, to make this attempt to 
have the point in question ascertained. 



It is perhaps unnecessary to add any further arguments to those of 
the able and judicious author, as to the specific difference of the dis- 
eases in question ; we cannot however help observing, that though 
both diseases affect the same parts, and are induced by the same 
means, yet that Syphilis appeared at least one hundred years before 
Gonorrhoea, and that it must be in the knowledge of almost every 
physician, that the termination of one of the diseases in the other, is 
so rare an occurrence (if it ever did happen) that we might apply 
the legal maxim, Excefitio regulam firobat. If any other argu- 
ment was necessary to prove the position of our author, we would 
draw it from the almost universal experience of the faculty in eve- 
ry part of the world, in the different mode of treatment which they 



SeC. I. GENERAL OBSERVATIONS, &C 37 

adopt in the two affections, as we believe that with very few excep- 
tions, Gonorrhoea is treated as a local, and'Syphilis, as a constitution- 
al affection. The few cases which occasionally occur, and which we 
have sometimes met with, where both diseases exist at the same 
time, in the same patient, constitute no rational objection to our doc- 
trine, as in some of the cases it could be incontestably traced to two 
different sources of infection, and in others the person from whom it 
was derived, laboured under both diseases. 

For a more detailed discussion of this question, we refer to Prac- 
tical Observations on the Natural History and Cure of the Venereal 
Disease, by John Howard, Fellow of the Royal College of Surgeons. 
London, 1806. Ed. 



CHAP. II. 

Of the Gonorrhoea Virulcnki. 

SECT. I. 

General Observations on the Symptoms, Causes, and Seat 
of Gonorrhoea Virulenta. 

EVERY discharge of matter from the urethra, 
excited by impure coition, is termed Gonorrhoea 
Virulenta. As the term implies a discharge of semen, 
and as this disease is not necessarily attended with any 
seminal evacuation, it is here obviously misapplied ; 
but we think it better to retain even a faulty denom- 
ination when very universally received, than to incur 
the hazard arising from the confusion which might en- 
sue from the proposal of amendments. 

The period at which the discharge takes place, after 
exposure to infection, is always uncertain. I have- 
known it happen in a few hours; often in the course 
of a day or two, and in some instances not till several 
weeks have elapsed. From the third or fourth day, 
to the seventh and eighth, is tijfe most frequent pe- 
riod. " v 



38 GENERAL OBSERVATIONS ON Ch. II. 

This does not appear, however, to have any effect 
on the nature or violence of the symptoms. Some in- 
deed have imagined, that the disease must be mild 
or severe according as it appears early or late after the 
matter of infection has been applied ; but this does 
not accord with my observation. I have often known 
the symptoms mild when they appeared early after ex- 
posure to infection, and severe when much time had 
elapsed. In one of the most obstinate cases of Gon- 
orrhoea I have seen, the running did not appear till 
nearly the ninth week from the time of infection. 
A gentleman sailed from Jamaica two days after having 
connection with a woman of suspicious character. No 
symptoms appeared till several weeks had elapsed ; 
he concluded that he had escaped ; when, two days 
before coming into port, being the fifty-eighth of his 
voyage, a very copious running appeared. 

In some few cases, the discharge takes place with- 
out the patient having any warning of its approach ; 
but, for the most part, it is preceded by symptoms in- 
dicating some degree of inflammation in the urethra: 
A sense of fulness and tightness is ie\t over all the un- 
der part of the penis ; the patient has a more frequent 
desire than usual to void urine, accompanied with a 
peculiar kind of itching heat along the urethra, at the 
same time that the extremity of that canal is observed 
to be of a more deep red colour than ordinary, and 
more than usually tender to the touch. In some cases, 
too, the urethra seems to be contracted, or lessened in 
its diameter ; the urine coming off in a stream much 
smaller than natural, while at other times it is forked, 
and as if the passage was divided in two. 

On the appearance of the running,it is sometimes white, 
and nearly of the consistence of purulent matter ; but, 
for the most part, it is thin, and of a yellow green 
colour. In some cases it is brown, resembling the dis- 
charge of old scorbutic sores, and in others it con- 
sists almost entirely of blood, owing to the erosion 
or rupture of one or more blood-vessels in the urethra. 



SeC. I. GONORRHOEA VIRULENTA. 39 

In a great proportion of cases, the discharge of mat- 
ter from the urethra, and scalding heat in making 
water, are the only symptoms which take place ; but 
in others, these are accompanied with chordee, or 
painful involuntary erections ; with much uneasiness 
in the testes, which frequently become so tender and 
irritable that the slightest touch excites pain. Severe 
degrees of pain often stretch from the penis to the 
groins and thighs; and in some cases ovtr all the ab- 
dominal viscera, particularly over the under part of 
the belly. 

In some cases the chordee, and in others these sym- 
pathetic pains stretching to the groins, and contiguous 
parts, are the most distressful symptoms of the disease. 
I have known ttie latter so severe as to render the 
patient altogether unable to take any kind of exercise; 
while the chordee, which is usually worst in bed, is 
apt to deprive him entirely of sleep. 

Besides these pains in the parts contiguous to the 
penis, and which we suppose to be chiefly the effect 
of nervous irritability, the glands in the groin in some 
instances swell, and become hard ; but unless the run- 
ning be accompanied with chancres, these swellings 
very commonly subside, and do not proceed to sup- 
purate ; an important fact, which may be considered 
as an additional proof to what was mentioned in the 
last chapter, of the difference between Gonorrhoea and 
Lues Venerea. 

In the course of the disease the glans penis some- 
times becomes red and inflamed, and a yellow, foetid 
matter, oozes from its whole surface. In some cases 
this is accompanied with evident ulceration : in others 
the skin remains entire, and the matter is observed, 
upon pressure, to proceed from an infinite number of 
small points. In both they are supposed to proceed 
from the matter passing out of the urethra, and al- 
lowed, by the negligence of the patient, to rest too 
long upon the tender cuticle of the glans. 

In some cases, however, this inflammatory affection 
of the glans, and discharge with which it is accompa- 
nied, takes place of itself, and without any discharge 



40 GENERAL OBSERVATIONS ON Cll IL 

from the urethra. In which case, from the resem- 
blance which the matter bears to that of Gonorrhoea, 
it has usually been termed Gonorrhoea Spuria. This 
inflammation, in some cases spreads to the prepuce, in 
which it very commonly produces some degree of 
contraction. When the prepuce becomes so much 
straitened that it cannot be drawn back, a disease is 
formed, which we term phymosis ; and, when it con- 
tracts behind the glans, a disease termed paraphimo- 
sis takes place. 

Although in Gonorrhoea some degree of uneasiness 
is usually felt along the whole course of the urethra, 
yet we know, that in most instances, the seat of the 
disease lies within an inch, or little more, of the point 
of the penis. In a few cases, however, whether from 
maltreatment of the disorder; from the nature of the 
infection being more than usually virulent, or from 
peculiarity of constitution of the patient, the disease 
spreads backward till it extends over the whole length 
of the urethra, even to the bladder itself. The prostrate 
gland and internal coat of the bladder become affect- 
ed, and sympathetic pains stretch from these parts 
along the ureters to the kidneys. 

When the bladder becomes in this manner diseased? 
the state of the patient is, for the most, extremely mis- 
erable : he feels almost a constant desire to make 
water, accompanied with severe pressure or bearing 
down upon the affected parts, proceeding from invol- 
untary spasmodic contractions of the abdominal mus- 
cles. The whole region of the loins, particularly a- 
bout the kidneys, becomes so painful and irritable, 
that much distress is excited by whatever tends to 
bring the muscles of these parts into action, and the 
patient often complains of a constant tenesmus, and 
of a freo^uent shooting pain about the anus and neck 
of the bladder. 

In this stage of the disorder there is seldom any con- 
siderable discharge from the urethra ; but, for the most 
part, a large quantity of very viscid, feetid mucus is 
discovered in the urine, which, in the course of a few 






SeC. I. GONORRHOEA YIRULENTA. 41 

hours, subsides, and adheres so firmly to the sides of 
the vessel as not to be easily separated. 

When a Gonorrhoea has either been improperly 
treated, or when much inflammation takes place from 
any other cause, the testes are apt U* swell and in- 
flame, and abscesses often form in Cowper's glands, 
as well as in other parts of the urethra. When these 
burst outwardly, or when the urine by any means finds 
access to them, they are often productive of great dis- 
tress to the patient and perplexity to the practitioner, 
as they frequently baffle every attempt that is made 
for removing them. 

It will readily be conceived that all the symptoms 
we have described are seldom or never met with in the 
same patient, and that these which do take place 
will be in very different degrees in different cases. 
This is particularly remarkable with respect to the 
quantity of discharge, which, in some instances, is so 
trifling as scarcely to excite anv inconvenience, whilst 
in others it is so profuse as to prove highly distressful. 
In some cases too, the heat of urine is so inconsidera- 
ble as not to deserve notice ; and in such instances 
also, the desire to pass water is seldom very frequent, 
while, in others, these symptoms are. both so insup- 
portable as to render the patient miserable. 

In most instances of Gonorrhoea any external inflam- 
mation which occurs is confined to the extremity of 
the urethra ; but in some cases, it runs so high as to 
spread over the whole glans, where it might be ex- 
pected to terminate, as inflammatory affections in 
other parts of the body most frequently do, in the for- 
mation of abscesses. This, however, very rarely hap- 
pens. We have observed, above, that, in a few in- 
stances, a purulent-like matter oozes from the whole 
surface of the inflamed glans ; but I have scarcely 
known an instance of any extensive abscess in the 
substance of the glans. The inflammation, for the 
most part, terminates by dispersion. In a few cases it 
ends in mortification. 

In women the symptoms of Gonorrhoea are, for the 

6 



42 GENERAL OBSERVATIONS ON CI). II. 

most part, much milder than in men. It sometimes 
happens that a flow of matter is all that occurs ; and, 
as the discharge is very similar to the matter of flu or 
albus, the two diseases are often mistaken for one 
another. 

This absence cf pain, however, takes place only 
where the vagina is the seat of the disease. When 
the urethra becomes affected the symptoms are near- 
ly the same as in the other sex. A distressful degree 
of irritation occurs at the extremity of the urethra, 
accompanied with heat of urine, and a very frequent 
desire to pass water. In some cases the inflammation 
spreads to the bladder, and even to the kidneys, ute- 
rus, and ovaria ; or at least these parts come to be so 
much affected with pain as to give cause to suspect 
thai they are in a state of inflammation. Pain, even 
in a severe degree, will no doubt occur from nervous 
sympathy, and this I believe to he frequently the case 
here ; but 1 have met with different instances of a 
considerable degree of inflammation being excited by 
Gonorrhoea in all the parts which I have mentioned : 
that is, they have become swelled, hard, and exces- 
sively painful, insomuch that the slightest touch would 
create a great degree of uneasiness ; and blood-letting, 
with other evacuations, were the only remedies from 
which relief was obtained. In some cases the matter 
is so sharp and acrid as to excoriate the clitoris, nym- 
pha?, and labia pudendi. This excites a great deal 
of uneasiness; more than ever takes place in men from 
a mere affection of the external parts; for, as these 
parts are in women pressed upon in sitting, the slight- 
est degree of inflammation is, from this cause alone, 
productive of much distress. They are often obliged 
to remain constantly in bed; being unable either to 
walk, stand, or sit. 

It is impossible, in any case of Gonorrhoea, to de- 
termine at first, in what manner it will terminate, for 
we often find the most severe, as well as the most ob- 
stinate discharge, succeed to symptoms of the mild- 
est nature, while in some cases it ends quickly and 



Sec. I. GONORRHOEA VTRULENTA. 43 

easily, where the symptoms at first were very severe. 
It is in general believed that the disease will be mild, 
and of short duration, where the running is white or 
yellow ; and, on the contrary, that it will necessa- 
rily prove severe and tedious, where it is at first green, 
or much tinged with blood. This, however, is by 
no means universally the case, for instances occur 
daily, of the running proving tedious, where it was 
at first of the colour and consistence of purulent mat- 
ter, while others often happen of its ending quickly, 
where the matter was at first either deeply tinged 
with biood, or of as deep a green as this discharge has 
ever been observed. 

In the progress of this disease, we always reckon 
it a favourable circumstance to observe the matter be- 
come thick and ropy. This cannot indeed be mention- 
ed as an infallible proof of the discharge being soon 
to terminate; but it is, undoubtedly, one of the most 
favourable occurrences in every case of clap. When 
the running does not soon become ropy, it is apt to 
terminate in gleet, the most perplexing symptom in 
this disorder, and of which we shall speak more par- 
ticularly in an ensuing chapter. 

_ VV e shall hereafter have occasion to observe that a 
discharge may be produced from the urethra by dif- 
ferent causes, very similar to the matter of Gonor- 
rhaea virulenta. At present it is only necessary to 
remark, that, in this disease, the discharge is obvi- 
ously the effect of irritation excited in the membrane 
of the urethra and contiguous parts, by matter horn 
an infected person being applied to them. 

Some difference of opinion has arisen on the manner 
in which the matter of infection is communicated to 
the urethra. By some it is supposed to happen in 
consequence of being first absorbed from the surface 
of the glans, and afterwards deposited on the mem- 
brane of the urethra; as they do not think that it can 
pass directly into the urethra, during coition. No 
good reason, how ever, can be given for this opinion : 
it appears more probable that the matter at first finds 



44 GENERAL OBSERVATIONS ON Oh. II. 

access between the lips of the urethra ; that it after- 
wards spreads, in a gradual manner, along the pas- 
sage, by mixing with the mucus, with which it meets, 
and that the progress which it makes will, in a great 
measure, depend upon the parts to which it is applied 
being more or less susceptible of inflammation ; upon 
the general state of health of the patient; upon his 
manner of living ; and perhaps upon other causes. 

I do not conceive, however, that t he kind of mat- 
ter by which the discharge is produced has so much 
influence on the violence or duration of the symptoms 
as has been imagined. It is indeed the opinion of some 
that a severe and obstinate case of clap may always 
be traced to an infection of some peculiar degree of 
virulency ; but this will not be found to happen with 
any kind of uniformity. So far as my observation 
goes; it is in Gonorrhoea nearly the same as in small 
pox. The mildness or violence of symptoms does 
not depend upon the matter by which the disease is 
produced so much as upon other circumstances. Hence 
the same woman will, under the same infection, com- 
municate the most virulent symptoms to one person, 
and the mildest to another. 

That much depends upon the habit of body of the 
patient, and upon his manner of living, will scarcely 
be doubted; but the following fact renders it obvious. 
Three gentlemen, who associated much together, and 
who were accustomed to live freely, returning one 
night from a drinking club, resolved to visit a girl of 
the town, and to take a friend along with them who 

d that night been a visitor in their society, but who 
1 ually lived with much sobriety. They all had con- 

ctipn with the same girl. The three associates had 
all the most severe claps I ever met with ; while the 

her, who also received the infection, had the dis- 

se in the mildest form. This would not, in similar 

re u instances, always happen, as we sometimes find 
p >ople who live with much circumspection, liable to 

:ry severe attacks of Gonorrhoea ; but, for the most 
irt, the degree of violence of this disease has a con- 



Sec. 1. GONORRHOEA VIRULENTA. 45 

siderable dependence on the manner of living of the 
pal lent. 

The matter discharged in Gonorrhoea being very 
similar to what is daily observed, to flow from sores 
in other parts, and the quantity being often very con- 
siderable, it was the prevailing opinion, till of late, 
that it proceeded from sores or ulcers in the urethra. 
We now know, however, (hat ulcers very seldom take 
place here ; and, when they do, that they may be 
traced to some accidental cause, such as the rupture 
of a blood-vessel, in no degree necessarily connected 
with the existence of the disease. On dissection, after 
death, it is found, almost in every instance, that the 
membrane of the urethra is entire, and that the matter 
is produced by inflammation alone. 

It had long been known, that instances were occa- 
sionally met with on dissection, where no degree of 
ulceration in the urethra was discovered. This, how- 
ever, was considered as a singular occurrence, and that 
it never happened but where the symptoms were un- 
commonly mild ; for at that time it was supposed, 
that ulceration, or a destruction of parts, was requisite 
for the production of matter. But we now know, that 
this is by no means the case, and that an inflamed sur- 
face, even where no abrasion is perceived, will pro- 
duce all the varieties of matter which sores ever afford, 
and that different kinds of animal fluids may be con- 
verted into these, merely by being kept in certain de- 
grees of heat. 

By this the difficulty is removed, which otherwise 
we must have experienced in accounting for the large 
quantities of matter daily discharged from the urethra 
in Gonorrhoea ; which, in some cases is so considerable, 
that nothing less than an affection of the whole extent 
of that canal could afford it. Now those who ima- 
gine that the matter proceeds from ulcers, have never 
gone so far as to say that this ever takes place : nor 
could it probably occur, but with such consequences as 
very seldom ensue from Gonorrhoea. What I allude 
to forms an unanswerable objection to the idea of ul- 



46 GENERAL OBSERVATIONS ON CI). II. 

cers being frequent in this disease, even although no 
opportunities had occurred of proving it by dissec- 
tion. Where the membrane of the urethra is in 
any point ruptured, either by the bursting of an ab- 
scess into it, or by any other cause, the most distress- 
ful consequences almost universally ensue ; for the 
urine passing into the contiguous parts, forms swel- 
lings, which usually terminate in fistulous openings, 
that prove always tedious, and of uncertain event. 
Every practitioner knows, that even the slightest 
opening into the urethra is apt to terminate in this 
manner; so that, if the matter of Gonorrhoea, pro- 
ceeded from ulceration, the consequences of almost ev- 
ery case of Gonorrhoea, would necessarily prove much 
more formidable than we ever, in any instance, find 
ihem to be. 

In cases of long continued Gonorrhoea, the membrane 
of the urethra is apt to be so relaxed, that fungous ex- 
crescences form in different parts of it. These not only 
impede the passage of the urine, but, becoming soft 
and tender, they at last ulcerate, and throw out very 
considerable quantities of matter. This however, is 
never to be considered as the cause of Gonorrhoea, 
but merely as the effect of it. It often proceeds from 
mismanagement, either on the part of the patient or 
practitioner; and sometimes from some constitutional 
affection to which the patient at the time may be lia- 
ble. 

Instead of ulceration, we find, that in a great pro- 
portion of cases, there is merely a slight degree of in- 
flammation, extending from the extremity of the glans 
to an inch or perhaps an inch and a half up the ure- 
thra. In more obstinate cases of clap, Cowper's glands, 
with their ducts, which terminate in the urethra, are 
found affected. In a third stage of the disease, the 
prostrate gland, and contiguous parts of the urethra 
are inflamed ; and in the fourth, and what may be 
reckoned the most distressful stage of clap, the inter- 
rial coat of the bladder is found inflamed. For the 
most part, the inflammation is confined to the neck of 
the bladder; but I have met with instances of its being 



SeC. I. GONORRHOEA VIRULENTA. 47 

perceptible over the whole of it, and of its even ex- 
tending along the ureters to the kidneys. 

This inflammation, however, is chiefly obvious at 
first. On a long continuance of the disease, the parts 
affected, instead of being either inflamed, or in a state 
of ulceration, are of a more pale colour than natural ; 
the membrane of the urethra is found soft and relax- 
ed ; and coloured mucus or matter may be pressed out 
from an infinite number of small points over every 
part of it that has been diseased. 

This is precisely what happens with every mem- 
brane that has remained long under a slight degree of 
inflammation, particularly with the membrane of the 
nose and trachea. These parts often afford very con- 
siderable quantities of matter, or of mucus very much 
resembling matter, for a great length of time : and yet, 
upon dissection, they are seldom or never found in a state 
of ulceration, the membrane being for the most part 
only slightly inflamed. We may here indeed remark, 
that the resemblance between the two diseases, Gon- 
orrhoea and Catarrh, is, in certain stages of each of 
them, very remarkable. They seem both to origin- 
ate from inflammation excited upon a membrane. 
The matter of the one is in many instances very simi- 
lar to that of the other. They seem both to be local 
affections only ; and the parts on which they are seat- 
ed are, after death, found to be affected in a similar 
manner. 

But although, in the latter stages of Gonorrhoea, in 
which, chiefly opportunities occur of examining the 
state of the parts after death, the inflammation is found 
to be for the most part inconsiderable, yet, in the com- 
mencement of the disease the parts are often highly 
inflamed, particularly when those about the neck of 
the bladder are affected. This is obvious from the 
symptoms particularly from the violent pain which al- 
ways takes place, and from the antiphlogistic reme- 
dies employed for the cure of the disease. 



48 GENERAL OBSERVATIONS Ox\ Ch. II. 

SECT. II. 

Of the Prognosis in Gonorrhoea Virulenla. 

IN every disease, it is of importance for a practition- 
er to be able to say at what time and in what manner 
it will terminate. In none is information of this kind 
more anxiously wished for than in Gonorrhoea. The 
hopes and fears of patients lead them equally to wish 
for it ; but, from various causes, and more particularly - 
from want of attention to the exact site of the disease, 
the duration of Gonorrhoea has always been a matter of 
much uncertainty. 

I have observed above, that, on dissection, four dif- 
ferent set of parts are found at different times to be 
the seat of Gonorrhoea. When the running proceeds 
from the extremity, or from within about an inch and 
a half of the extremity of the penis, as happens in per- 
haps nine cases out of ten, there will for the most part, 
be much cause to hope that a cure will soon be obtain- 
ed. In such instances, when the patient is otherwise 
in good health, and when he does not interrupt the % 
operation of the necessary remedies by improper con- 
duct, the disease will not commonly endure a fortnight. 
Nay, a cure in such circumstances is often obtained in 
two or three days: but whenever the lower parts of 
the urethra are affected, particularly when the pros- 
trate gland and other parts about the neck of the blad- 
der are diseased, the running, in almost every instance, 
proves obstinate. Even our most powerful remedies 
in other cases of clap are here doubtful in their effects. 
Hence no certain opinion can be formed of the event 
of the disease. 

When these deep-seated parts are affected, the dis- 
ease proves always tedious, whatever the habit of body- 
may be ; but it necessarily proves much mqre so when 
the constitution labours under any general affection, 
particularly when scrophula prevails, than when the 
patient is sound and healthy. Indeed a scrophulous 
taint existing even with the most simple case of clap. 



SeC. II. GONORRHOEA VIRULENTA. 49 

is apt to render it obstinate ; I am so much convinced 
of this being the case, that in every instance of clap 
occurring in scrophulous patients I always give a 
guarded prognosis of the event. Cures are sometimes 
indeed obtained easily, even in patients of this de- 
scription ; but, for the most part, the discharge goes on 
for a great length of time, and resists the effect of eve- 
ry remedy we employ to remove it. 

This uncertainty which takes place in ihe treatment 
of Gonorrhoea, and the great length of time to which 
the discharge, in some instances goes on, together with 
the many untoward and unexpected occurrences which 
often happen during the cure, tend altogether to 
render this branch of practice the most distressful of 
any in the province of medicine. In a great pro- 
portion of cases, a cure wilh proper treatment is easi- 
ly and speedily obtained ; but every candid practition- 
er will admit that cases often occur in which the dis- 
charge continues obstinate for a great length of time, 
even under the use of the most powerful remedies with 
which we are acquainted. But, by distinguishing be- 
tween one stage of the disease and another, and thus 
giving an opinion to patients of the probable event of 
it, practitioners w ? ou!d avoid a good deal of embarrass- 
Ynent w r hich they often experience, from giving so in- 
discriminately as they commonly do, a favourable prog- 
nosis at the commencement of every case of clap. 

In forming a prognosis, it ought always to be kept in 
view, that however mild the symptoms may be at first, 
they may very quickly and unexpectedly become se- 
vere, by the disease proceeding from one part of the 
urethra to another, or even by the inflammation in the 
part which was at first affected becoming more severe. 
This arises from various causes, and often from cir- 
cumstances which it is not in the power of practitioners 
to prevent. It sometimes occurs, indeed, from the use 
of improper remedies ; particularly from acrid injec- 
tions being used with too much freedom ; but it hap- 
pens much more frequently from other causes, partic- 
ularly from the tendency which inflammation in one 



50 GENERAL OBSERVATIONS ON THE Cb. II. 

part of a membrane basto spread itself over tbe wbole 
of it, and to tie misconduct of patients, who, instead 
of living as they ought to do, very commonly proceed, 
during the cure, in the same course of riot and de- 
bauchery by which they were at first exposed to in- 
fection. Some patients, even under such circumstan- 
ces, will no doubt get well ; but there is not a more 
undoubted fact than this, that the cure of the disease is 
for the most part both difficult and uncertain where 
the patient lives in a riotous and intemperate manner. 



No situation is more delicate, or more exposed to censure than the 
one in which the pnysician is placed when called upon to give an 
opinion on the probable continuance of a disease. This is particu- 
larly the case in Gonorrhoea. The impatience, as well as imprudence 
of the description of persons who are most liable to this complaint, 
render a prognosis extremely uncertain. Much depends on the 
habits and mode of life of the patient, his constitutional tempera- 
ment, and the diseases (if any ^ to which he has been subjected, or is 
predisposed. As a general rule, it may be observed, that in persons 
of a sanguine temperament, and accustomed to live freely, the in- 
flammation will be more violent in its progress, but with proper cau- 
tion may be removed in a shorter period, than in individuals of a dif- 
ferent constitution. It ought to be impressed on every patient that 
temperance and rest are indispensible in order to effect a speedy- 
cure. The difference of climate and seasons have considerable in- 
fluence on the degree of inflammation excited. Hot weather tends to 
render the discharge considerable and acrimonious, and in the spring 
or beginning of summer the tendency to inflammation is greater, and 
the symptoms are generally more aggravated than at other seasons 
of the year. Ed. 



SECT. III. 

General Ohservations on the Cure of Gonorrhoea 
Virulenia. 

GONORREKEA, as I have observed above, has s 
till of late, been very generally considered as depend- 
ing upon an affection of the constitution ; or at least 
the discharge has been supposed to be of such a nature 



Sect. III. CURE OF GONORRHOEA VIRULENTA. 51 

as at all times to affect the constitution, and therefore 
that a cure could not he obtained bnt by the use of 
remedies which operate upon the system at large, 

For a considerable time mercury was chiefly relied 
upon. It was employed on the supposition of Gonorr- 
hoea being a symptom of Lues Venerea ; but experience 
having shewn that no advantage was derived from mer- 
cury by itself, other remedies were employed along 
with it. These consisted chiefly of demulcents, evae- 
uants, and astringents. 

By a plentiful use of mucilaginous drinks, and oth- 
er demulcents, it was meant to sheath the bladder and 
urethra more effectually from the acrimony of the u- 
rine, and at the same time to render the urine itself less 
acrid. Purgatives were employed for the purpose of 
carrying off the morbid matter of the disease, and nitre 
and other remedies were given with a similar intention ; 
and lastly, as the running was seldom lessened by the 
use of any of these, but, on the contrary, being fre- 
quently increased, bark, astringent balsams, and other 
corroborants, were prescribed for putting a stop to it. 
In some cases mercury was continued during the whole 
course ; in- others it was left off at the time of entering 
upon the use of astringents. 

The practice of physic when this prevailed being in 
most points highly improved, we are astonished to find 
such deficiency as this evinces, in the treatment of a 
disease which necessarily fell under daily observation. 
If patients had been left to themselves, without any in- 
terference on the part of practitioners, the disease 
would often, in the course of time, have disappeared 
without any injury being done to the constitution ; for 
Ave know that a simple clap will, in most instances, dry 
up whether any remedies be employed or not ; but, by 
the liberal use of strong purgatives, and especially when 
this was conjoined with a low diet and a course of mer- 
cury, the constitution was so much debilitated that 
this alone rendered almost every case that occurred 
exceedingly obstinate : hence Gonorrhoea was consid- 
ered as the most distressful as well as one of the most 



52 GENERAL OBSERVATIONS ON THE Ch. II. 

dangerous diseases to which the human species was lia- 
ble. Lues Venerea was, for the most part, easily cu- 
red by mercury ; but no advantage was derived from 
this remedy in Gonorrhoea : the disease usually proved 
exceedingly obstinate, and was very apt to terminate 
either in gleet or in obstructions of the urethra. 

It soon appeared to practitioners of observation, that 
the medicines employed in Gonorrhoea, instead of pro- 
ving useful, rather did harm ; but the period was not 
yet arrived in which a more effectual remedy was to 
be proposed. Some, however, went so far as to say 
that medicines of every kind might be avoided, as they 
bad found, from experience, that the disease went off 
both more easily and more quickly when left to itself 
than it ever did with the remedies at that time in gen- 
eral use. A low diet, mercury, and evacuants, of dif- 
ferent kinds, did much harm, as we have already obser- 
ved, by inducing such a degree of debility and relax- 
ation as materially affected the constitution ; and the 
drastic purgatives, of which large doses were given 
daily, proved highly prejudicial, by the irritation which 
they excited. In certain stages of clap a strong 
purgative never fails to increase the pain ; .to excite a 
more frequent desire to make water, and to increase 
the discharge : nay, I have known various instances of 
a return of all the symptoms of Gonorrhoea being in- 
duced by the operation of a brisk purgative, long after 
the patient considered his cure as complete. 

We need not therefore be surprised at the proposal 
of laying all such remedies as these aside ;and it must 
be admitted that a cure will often take place, that is, 
the running would disappear, together with all the 
symptoms which attend it, without the aid of medi- 
cine. This would frequently happen where the dis- 
ease was mild; where the patient was possessed of a 
healthy constitution ; and where the running was not 
kept up by any impropriety on the part of the pa- 
tient. The running would disappear here, as happens 
in coryza and other instances of matter proceeding 
from inflamed surfaces, whether any remedies should 



SeC. III. CURE OF GONORRHOEA VIRULENTA. 53 

be employed or not : but this would seldom or never 
happen where the symptoms were severe, nor where 
the patient did not live in every respect as he ought to 
do. In all such cases the cure would prove tedious 
and uncertain, and the constitution would frequently 
be ruined, in the attempt. 

When the mode of cure we have mentioned was 
proposed, an opinion prevailed that the discharge was 
kept up by some general affection of the constitution, 
and that nothing therefore could be so safe or so pro- 
per as to allow it to run as long as any part of the mor- 
bific matter by which it was produced, continued. It 
was at that time admitted by all, that Gonorrhoea was 
of the same nature with Lues Venerea. Chancres, as 
well as all other venereal sores, were kept open till 
cures were obtained by the internal use of mercury. 
An erroneous idea prevailed of some advantage being 
derived from the discharge which they produced ; and 
hence even by those who saw clearly that no benefit 
was obtained from mercury in Gonorrhoea, it was still 
considered as the best practice to allow the disease as 
they said, to discharge itself in this manner. 

Even granting that the matter of Gonorrhoea was 
the same with that of Lues Venerea, there is no cause 
to imagine that any advantage would ensue from this 
practice ; but we now have no reason to doubt of the 
two diseases being perfectly different. A practice, 
therefore, which at one period might have been judg- 
ed proper in one disease, would now be inapplicable 
in the other ; and hence it has, veiy generally, been 
laid aside, although not yet given up by some individ- 
uals. 

From the observations we had occasion to make in 
the last chapter, as well as from other circumstances, 
few will now doubt that the matter in Gonorrhoea pro- 
ceeding in most instances from an inflamed state of the 
membrane of the urethra and contiguous parts, gives 
a local affection only, without being productive of any 
general disease of the constitution. From this view 
of the subject, it is obvious that no great advantage is 



54 GENERAL OBSERVATIONS ON THE Ch. II. 

to be expected from remedies applied to the system at 
large, and that a cure is to be looked for from the use 
of local remedies only. In the treatment of a simple 
sore, of a cut, a burn, or excoriations from any cause 
whatever, we would not surely expect to succeed by 
mercury, purgatives, or any remedies directed to the 
constitution. In all such affections we trust to local 
remedies, unless the presence of fever, or some other 
general affection, render other remedies necessary. 
For the same reason we ought, in Gonorrhoea, to de- 
pend entirely upon such remedies as act chiefly upon 
the parts affected ; no others being necessary if it be 
not occasional blood-letting, and other evacuations, 
and these only where fever, plethora, or much inflam- 
mation take place. 

In local affections of other parts, our remedies are 
easily and directly applied : in the urethra some nice- 
ty and attention is necessary, not only in the mode of 
applying them to the diseased parts, but in judging of 
the period of the disease, or rather of the state of the 
parts to which they are to be applied : in other situ- 
ations these circumstances fall directly under view, 
and we judge from appearances of the propriety of ap- 
plying one remedy or another. In the urethra we 
are directed entirely by the symptoms, and we judge 
from these of the remedies to be employed, as well as 
of the parts to which they are to be applied being in a 
fit state for receiving them or not. 

If the parts affected in Gonorrhoea were always the 
same, no difficulty would occur in the application of 
our remedies ; but, although the matter in the com- 
mencement of the disease proceeds in perhaps every 
instance from inflammation, yet, in some, parts are 
affected with inflammation, to which it would be im- 
proper and even hazardous to apply the same reme- 
dies which in a great proportion of cases are used 
with much safety and advantage. 

We shall afterwards have occasion to shew that, in 
certain circumstances of Gonorrhoea, bougies may be 
used with much benefit; but, for the most part, we 



Sect. in. cure of gonorrhoea virulenta, 55 

depend entirely upon injections, and chiefly upon such 
as are of a drying astringent nature. Now it is obvi- 
ous, that although we may with safety apply an astrin- 
gent solution to an inflamed surface, as happens dai- 
ly where the membrane of the urethra only is affected, 
yet that much risk may ensue from the same solution 
being applied to the ducts of inflamed glands : in the 
one case the discharge produced by the inflammation 
will be lessened and soon removed, and the inflamma- 
tion itself will subside, while, in the other, by a sud- 
den stop being put to the discharge of a gland already 
in a state of increased irritability, more inflammation 
will be excited, the parts affected will become swelled 
and painful, and at last the discharge will burst forth 
with redoubled violence. 

That this frequently happens in the course of busi- 
ness, every practitioner of candour will admit: nay, 
there are few paiients who have been liable to differ- 
ent attacks of this discharge, who have not met with 
it in some degree. For a day or two the running will 
olten disappear, and they consider tile cure as com- 
plete, when after some degree of tension and uneasi- 
ness along the greatest part of the penis, particularly 
in the perineum, the discharge recurs as before, with 
every appearance of a recent infection. 

As there are many who condemn the use of injec- 
tions in Gonorrhoea, it is alledged that this is one of the 
inconveniences which they produce ; but we shall 
presently have occasion to shew that this is by no 
means the case, and that it proceeds entirely from a 
misapplication of the remedy ; from using it in a state 
of the disease for which it is impi per ; and not from 
the remedy itself being of a hazardous nature. 

This leads us to revert to the necessity there is for 
distinguishing between one state of Gonorrhoea and 
another. In the description of the symptoms, I re- 
marked that they are evidently distinguishable into 
four sets, indicating four states or stages of the dis- 
ease : and as it is a point of the first importance in prac- 



56 GENERAL OBSERVATIONS, &C. Ch. II. 

lice to have these different states clearly marked, we 
shall now proceed to treat of them in separate sections, 



As the. author has mentioned the internal use of Mercury in Gon- 
orrhoea in this section, a few observations on its curative effects 
may not be misplaced. A notice of other remedies will be found in 
succeeding sections. 

The idea that mercury operates in Gonorrhoea in a similar 
manner to what it does in Lues, namely, by a specifick action, ap- 
pears at present to be generally abandoned. The point is indeed con- 
clusively decided by the fact, that the former disease is in numerous 
instances cured without the exhibition of a single grain. Its utili- 
ty must of course be derived from other properties, and those are 
probably its powers in changing a diseased to a healthy secretion. 
Analogy is in favour of this opinion, as well as the testimony of prac- 
tical men. 

Mr. Howard recommends its use in the form of calomel after the 
inflammatory symptoms have subsided, and the chordee is gone. 
At this period, the urethra is in a state of debility, and the stimulus 
of the medicine which in the preceding stage, would have been 
injurious, is not at present to be dreaded. The quantity administer- 
ed should not exceed two or three grains of calomel during the 
twenty-four hours, and this to be continued for a few days only. The 
exhibition of mercury by friction (Ung : Hydrarg : fort : ) either to 
the perineum, glans penis, or thigh, is seldom, if ever, proper. In 
the Contributions to Medical Knowledge, published several years 
since by Dr. Beddoes, there is a paper by Mr. Addington, a sur- 
geon in the west of England, in which he states his having cured 
hundreds of cases of Gonorrhoea, in a very short space of time, by 
giving Corrosive Sublimate internally. Three grains of it are to be 
dissolved in one ounce of rectified spirits of wine, and half of this 
mixture is to be taken undiluted when going to bed. On the second 
day after, a dose of Sulphate of Soda is to be taken, and in the even- 
ing, the remainder of the mixture. The salts are repeated in two 
days after. A violent and profuse salivation for one or two hours, 
is the consequence of this treatment, but there is no doubt of it& 
curative effects. It has lately been used with success in this city. 

As a general rule of practice, we must take the liberty to ob- 
serve, that with proper care and attention, mercury is but little need- 
ed as an internal medicine. In ordinary cases, other remedies will 
suffice. In instances however, where the discharge from the ure- 
thra is acrimonious and large in quantity, the exhibition of calomel 
will be found useful. This is also the case in some of the conse- 
quences of Gonorrhoea,. Ed. 



Sect. IV. OF THE FIRST STAGE, &C. 57 

SECT. IV. 

Of the First Stage of Gonorrhoea. 

IN the first stage of Gonorrhoea, the running is never 
accompanied with violent symptoms. The extrem- 
ity of the urethra becomes red, full, and somewhat 
prominent. The glans become tender and irritable, 
and ardor urince takes place in a greater or lesser de- 
gree, according to the extent of the inflammation. 
For the most part the heat of urine is inconsiderable; 
but in some instances, even in this stage of the dis- 
ease, it is so severe as to excite a good deal of dis- 
tress. Chordee sometimes occurs, but seldom in any 
considerable degree. 

In the history of the disease we have seen, that in 
this stage of it, the membrane of the urethra alone is 
affected, that is, the inflammation by which the dis- 
charge is produced has not extended to any other 
part. 

We judge that this is the case when these symptoms 
only occur which have just been enumerated ; when no 
glandular swellings are discovered along the course of 
the urethra, and particularly when the running pro- 
ceeds entirely from within an inch, or an inch and a 
half of the extremity of that canal. 

Tills circumstance of the discharge in Gonorrhoea 
proceeding from the extremity of the urethra, is at all 
times a proof of the inflammation not having adranced 
farther than to constitute what I have denominated the 
first stage of the disease. No glandular swellings are 
ever discovered while the running proceeds from these 
parts ; and on dissection after death, the membrane of 
the urethra alone is found inflamed : but in some in- 
stances the discharge proceeds even from the superior 
parts of the urethra, while none of the contiguous 
glands are affected. This I consider as constituting 
the first stage of the disease, equally as when the ex- 
tremity of the urethra is alone affected. The symp- 

8 



58 OF THE FIRST STAGE Ch. II, 

toms are not more violent in the one than in the other, 
and the method of cure is the same in both. It must, 
however, be admitted, that we do not frequently meet 
with this; for where the upper part of the urethra is 
affected, the inflammation is very apt to spread to the 
contiguous glands, and thus terminates in the second, 
third, or, perhaps, fourth stage of the disease. 

We ascertain the place in the urethra, from whence 
matter is discharged, not merely from the height to 
which the pain or uneasiness with which it may be ac- 
companied extends, for this proves often an equivocal 
mark of distinction, but from compressing the passage 
at any given spot, and pressing out all the matter be- 
tween it and the end of the urethra. If, on removing 
the pressure, more can be brought down, we are sure 
that it must come from a greater height, and by pro- 
ceeding in a gradual manner upwards we may thus, 
with very little attention, discover almost the exact 
spot from whence the discharge proceeds. It will af- 
terv\ards appear that our being able to do so is of im- 
portance in conducting the cure. 

From what has been said it will appear, that in this 
stage of the disease the running proceeds entirely from 
inflammation of the membrane of the urethra, with- 
out any affection of the glands which open into it ; 
and in the removal of this, the cure entirely consists. 

Where the inflammation is considerable, as we judge 
to be the case when the ardor urinal is severe, and 
especially when it occurs in a very full habit of body, 
it may be proper to prescribe blood-letting, a dose or 
two of any gentle laxative, and a low, cooling diet. 
At the same time violent exercise of every kind should 
be avoided, particularly riding on horseback. 

Inflammation, however, in this state is seldom so 
considerable as to render blood-letting necessary : in 
ordinary cases we now trust to the use of injections 
alone, and in all periods of the discharge I use them 
with equal freedom. Even where blood-letting, and 
a strict attention to an antiphlogistic regimen is neces- 
sary, I have never any difficulty in beginning immedi- 
ately with the use of injections. 



Sec. IV. OF GONORRHOEA. 59 

Those who are not in the daily practice of using in- 
jections, are afraid of prescribing them so generally as 
they ought to do ; some, indeed never employ them 
in any case, from the prejudice being strong which still 
prevails against them among almost all the older prac- 
titioners, while others admit that they may be used 
with safety and advantage, in the latter period of the 
disease, but never in the beginning, or while the inflam- 
mation continues in any degree severe. 

This, however, is a timidity that will soon vanish 
with all who venture upon a more general use of them. 
They will find that injections, of a sufficient degree 
of astringency for removing the discharge, may in 
this state of Gonorrhoea be employed with perfect 
safety, even in the commencement of the disease, and 
whether the inflammation which takes place be mild 
or severe. 

An idea is still entertained by many, that the run- 
ning should not be stopped till some of the virulency 
by which it was produced is carried off ; and hence 
they object, as we have just observed, to the early use 
of injections. But, as we have seen that Gonorrhoea 
is a local affection, and as we know that in other parts 
of the body local inflammation may at all times be re- 
moved with safety, nay, that it is the best practice 
to attempt it, we might from this alone infer, that it 
would be equally proper here. But independent of 
this, I can with confidence assert, and all who employ 
injections generally will do so, that they may in this 
stage of Gonorrhoea be used at all times, and with more 
certainty of proving successful the more early they 
are applied. Of this I am so clearly convinced, that I 
would advise all who have it in their power, to em- 
ploy injections instantly on the discharge taking place. 
They commonly, indeed, prove successful at whatever 
period they are used; but I have uniformly found that 
they act more quickly in the commencement of the 
disease than in the latter stages of it. 

While practitioners differ in opinion respecting the 
most proper period of Gonorrhoea for using injections, 



60 OF THE FIRST STAGE Cll. II. 

they likewise differ in their ideas of the kinds of these 
remedies best calculated for the periods in which they 
are employed. In the commencement of Gonorrhoea, 
and at all times when much pain takes place, it is the 
opinion of many that emollient injections only ought 
to be used, such as warm oil, emulsions of almonds, in- 
fusions of althea, and lintseed : but in this there ap- 
pears to be some mistake ; and I can decidedly say so 
from having often experienced the inefficacy of the 
practice. 

On first entering upon business, I found it the opin- 
ion of many who used injections with freedom, that 
those of the emollient kind ought alone to be advised 
while much heat of urine, or any considerable degree 
of inflammation continued. These, it was imagined, 
would sheath and protect the parts from the acrimony 
of the urine, and on the inflammation subsiding, they 
conceived that injections of an astringent nature might 
be used with more safety. The opinion was plausible, 
and supported by some of our best practitioners ; I 
was therefore induced, along with others, to go into 
it ; but it soon appeared that no advantage was to be 
derived from it : on the contrary, it was evidently the 
cause of much distress, by rendering the cure of 
Gonorrhoea much more tedious than it otherwise might 
have been ; for injections of the emollient kind never 
tend to shorten the continuance of the discharge, and 
often render it more fixed and permanent, by relaxing 
the parts from whence it proceeds. 

Neither are injections of this description necessary as a 
preparative to those of the astringent kind : in this 
conviction I have for many years past laid them alto- 
gether aside, and during this period have used none 
but such as are evidently astringent ; and although I 
employ them with all manner of freedom, I have never 
perceived any bad effects arise from them. 

In this stale of Gonorrhoea, injections of the astrin- 
gent kird may be used with safety and advantage, from 
the very commencement of the discharge, as well as at 
any period of the disease, whatever the degree of in- 



SeC. IV. OF GONORRHOEA. 61 

flammation may be. Instead of increasing the in- 
flammation, they tend, when of a proper strength, to 
lessen it ; they relieve more immediately than any oth- 
er remedy, the ardor urinae; and they commonly les- 
sen or remove the discharge in a very short space of 
time. 

In all cases, therefore, of this kind, where we sup- 
pose the disease to proceed entirely from the mem- 
brane of the urethra, I pay no regard to the continu- 
ance of the running ; the patient is immediately put 
upon the use of injections, and no harm ever ensues 
from it. 

There is only one symptom which, in this stage of 
clap, precludes the immediate use of injections, viz. 
pain and swellings of one or of both testes : a persever- 
ance in the use of injections during the continuance 
of this symptom very commonly does harm, and 
ought not therefore to be advised ; not that they tend 
to increase the inflammation, even of the testis, but 
by removing the discharge from the urethra, they de- 
prive us, as we shall afterwards see, of one of the most 
effectual remedies for a swelled testicle, proceeding 
from Gonorrhoea. 

>, A variety of astringent injections are employed by 
practitioners, but some proving more effectual than 
others, an investigation of this part of our subject is 
thereby rendered necessary. 

Almost any astringent injection will lessen the dis- 
charge. Port wine, and elaret, duly diluted, some- 
times answer. I have often succeeded with a tea-spoon- 
ful of brandy added to half an ounce of rose water : 
nay, rose water itself, or even cold water directly 
from the spring, will often give a stop to the discharge ; 
but, for the most part, the effects of these are only 
temporary. In slight affections, indeed, they some- 
times complete the cure, but in general we are under 
the necessity of employing astringents of a more pow- 
erful kind. 

Among the first injections used in Gonorrhoea, mer- 
cury, in one form or another, was a constant ingredl- 



62 OF THE FIRST STAGE Ch. II. 

ent. It was not, however, employed as an astringent ; 
for at that period the use of astringents of any kind 
would have been considered as hazardous. Being ap- 
plied in this manner directly to the seat of the disease, 
it was supposed that it might act as a specific in the 
cure of it. But although I have given full and com- 
plete trials to injections of the mercurial kind, and in 
every variety of form, I have npt, in any instance, 
found them to prove more effectual than other astrin- 
gents. In order to ascertain the point to which I al- 
lude, with as much certainty as possible, I have re- 
peatedly made it the subject of experiment. Of dif- 
ferent patients in Gonorrhoea, all nearly distressed with 
similar symptoms some have been made to employ a 
mixture of calomel with mucilage and water ; others 
have used quicksilver dissolved in mucilage, while 
some have at the same time been using injections in 
which mercury did not enter as an ingredient. 

I admit that in most of these instances mercury prov- 
ed serviceable, but by no means in such a degree as 
many of the articles with which it was put, upon this 
comparative trial. There is no cause, therefore, to 
imagine that it acts as a specific in the cure of clap. 

To prevent interruption in this part of the work, 
formulae will be given in the Appendix to this volume, 
of ail the preparations I wish to recommend. Of mer- 
curial astringent injections, the prescriptions No. I, 
2, and 3, are perhaps the safest and best that can be 
used. 

Calomel used in injections seems to act in a similar 
manner with lapis calaminaris, armenian bole, and oth- 
er astringent earths; not by any specific virtues with 
which ihey are endowed, but by restoring tone to parts 
weakened by the disease. It is in this manner, I con- 
clude, that ail of these articles act in the cure of Gon- 
orrhoea ; and in cases that are not particularly obsti- 
nate, they very commonly prove effectual. Lapis 
calaminaris, ortutia finely levigated, suspended in thin 
mucilage, makes a very safe and useful injection. No, 
4th and 5th are formulae of these ; and No. 6 is a pre- 



SeC. IV. OF GONORRHOEA. 63 

scription of a gentleman retired from business, who, 
at one period, was in very extensive practice in Lon- 
don, and who in the course of much experience in this 
particular branch, gave the preference to articles of 
this kind over all others that he ever employed. 

These earths possess one important advantage for 
this purpose : they never do harm, in whatever quanti- 
ty they are used. If levigated with sufficient care and 
attention, they may be used in any quantity that the 
liquid in which they are conveyed can be made to sus- 
pend. 

Alum dissolved in water makes a safe and useful 
injection. It proves equally safe, and still more pow- 
erful, when conjoined with a decoction of oak bark, 
or an infusion of galls, for which prescriptions are 
given No. 7th, 8th, and 9th. 

Kino, an astringent lately much used in Diarrhoea, 
proves also an useful ingredient in injections for Go- 
norrhoea. I have in various cases found it prove suc- 
cessful where other articles had failed, and I have not 
observed that it ever does harm. As it is not very 
soluble in water it becomes necessarry to suspend it 
when in fine powder, by means of mucilage, as is pre- 
scribed No. 10th and 11th. 

Opium proves often an useful ingredient in injections 
of this kind ; and as it is equally serviceable whether 
much pain takes place or not, I conclude that it does 
not act so much as a sedative as it does as an astringent. 
No. 12th and 13th are formulae of injections with 
opium. 

Some of the astringent balsams, properly combined 
with water, make a good variety of injection for Go- 
norrhoea, particularly the balsamum canadense, and 
balsamum copaiba, as in No. 13th, and 14th. 

Lead, in various forms, proves highly serviceable 
in these injections. Cerusse suspended in mucilage 
and water is often employed with advantage ;but ace- 
tum lythargyri, and saccharum saturni dissolved in 
water are most to be depended on. Formulae of these 
are given in No. 15th ? 16th, and 1 7th. 



64 OF THE FIRST STAGE CI). II. 

Of all the astringent injections, however, which I 
have used, none prove so powerful as white vitriol 
dissolved in water. In the quantity of a grain and 
half to an ounce of water, it seldom creates much ir- 
ritation, and it does not often fail in this variety of the 
disease, in which alone injections of any kind ever 
prove materially useful. No. 18th is the form of in- 
jection, which, in the common occurrences of daily 
practice, I am in the habit of using ; and No. 19th is 
a combination of vitriol and acetum lythargyri, which, 
in a few cases, I have found to answer better than 
either of these articles separately. 

Many other astringents might be enumerated, from 
which very useful injections might be prepared, but 
the formulae which I have given contain the most pow- 
erful of any with which we yet are acquainted. None 
of them will at all times prove successful ; for even in 
this the most simple variety of the disease, the most 
active remedies will in some instances fail : but I can 
from experience in this branch of practice assert, that 
it will seldom happen where the injection is properly 
managed and duly persisted in. 

The vitriolic injection, No. 19, I have mentioned 
as the most useful formulae of any ; but it will some- 
times happen that a case will readily yield to others 
which has long resisted this. When we do not, there- 
fore soon succeed with one injection, we ought, with- 
out loss of time, to have recourse to others, by which 
our purpose will be more easily accomplished than by 
continuing to employ the same for any length of time 
together. 

In all these injections the different ingredients are 
in such proportions as best suit the general course of 
business. This was a point of much importance to 
ascertain, and so far as my observation goes, I have 
done so ; but cases will no doubt occur from time to 
time, in which some variety of strength is necessary. 
All injections of this kind should be of such a strength 
as to excite some degree of irritation in the urethra, 
but by no means so strong as to create much pain : 



Sec. IV. OF GONORRHOEA. 65 

hence, where the preparations I have mentioned do 
not answer the purpose, they should be made stronger; 
and when of such a strength as to excite severe pain, 
they should be more diluted. 

This, I may remark, is an object requiring much 
attention, for while it is obvious that injections must 
do harm when their strength is more than it ought to 
be, it is equal!}' certain that little or no advantage 
will be derived from them when they are too weak. 
I have known a cure accomplished in three days, 
merely by making an injection of a sufficient strength, 
where the disease had previously gone on for two or 
three months, from want of attention to this point. 
I consider this, indeed, as one of the most important 
points in the treatment of Gonorrhoea, nor does any 
thing distinguish the practitioner of experience with 
such certainty, as his being able to adapt the strength 
of the injections which he employs to the particular 
circumstances of every case which falls under his man- 
agement. 

In the application of injections there are two cir- 
cumstances which more particularly require attention, 
viz. the manner of throwing them up, and the frequen- 
cy of using them. 

They may be thrown up either with a small bag of 
resina elastica, fitted with a pipe, or with a common 
small syringe ; whether the bag or syringe be used, 
the pipe should be perfectly smooth, of a conical form, 
not above half an inch in length, and the cone of such 
a thickness near to the root, as not to allow the pipe to 
pass above a quarter of an inch into the urethra. 

The bag or syringe being filled with the injection, 
and the patient seated with his breech over the side of 
a chair, so as to prevent the perineum from being pres- 
sed upon, the pipe, when well oiled, should be insert- 
ed into the urethra, as far as it will go, with the right 
hand, while, with the left, he grasps the penis, and pulls 
it forward upon the pipe. He must now throw the in- 
jection up in such a manner that it may reach the far- 



66 OF THE FIRST STAGE Ch. II, 

thest part of the urethra that is affected, but not 
with such force as to excite pain. 

When the discharge proceeds from near the extrem- 
ity of the penis, very little force is required for this 
purpose ; but when the upper part of the urethra is 
affected, if the injection be not thrown up with some 
degree of firmness, it will not reach the seat of the 
disease, and hence no advantage will be derived from it- 
Previous, therefore, to the use of injections, the part 
of the urethra, whence the discharge proceeds should 
be ascertained, and it can be easily done in the manner 
we have mentioned above. 

In using injections it is judged proper by some to 
desire the patient to prevent them from passing farther 
in the urethra than the seat of the disease ; lest, by 
forcing some of the matfer along with the liquid, the 
infection should be carried to parts which otherwise 
might not have been injured. For this purpose the 
patient must compress the urethra with the middle 
ringer of his left hand, at that point to which it is 
meant the injection should go ; while the syringe or 
elastic bag is employed for throwing it up in the other. 
But although there is necessity for throwing injections 
farther than ttie seat of the disease, there is no cause 
for this anxiety in preventing them. It does not appear, 
that in this manner, the infection is ever communicated 
from one part of the urethra to another; at least I have 
never met with an instance of it, and I have seldom 
pointed out this to my patients as a necessary piece of 
attention. While it does not therefore, answer any 
good purpose, it certainly renders it more difficult for 
the patient to throw the injection properly up, as he 
cannot both make pressure upon the upper part of the 
urethra, and, at the same time, manage the syringe 
with that exactness which it requires. 

The point, however, of most importance in the use 
of injections is, the frequency with which they should 
be thrown up ; it is not enough that we discover a 
composition that will establish a cure, if we do not use 
it with that frequency which the nature of the disease 



Sec. IT. OF GONORRHOEA. 67 

requires. In common practice the patient is desired 
to inject the liquid two or three times a day : this, if 
the injection be of a proper strength, will in course 
of time effect a cure ; but I am perfectly convinced 
from much attention to the subject, that cures would 
be much more speedily obtained were injections to be 
more frequently thrown up. Instead of two or three 
times a day, I cause them to be used seven, eight, or 
ten times daily ; by which the cure, instead of being 
protracted for several weeks, is often completed in as 
many days. 

This, I must observe, is a point of such importance 
in the cure of Gonorrhoea, that nothing can compen- 
sate the neglect of it. The inefficacy of injections is 
frequently held forth as one material objection to 
them, but, for the most part, their failure will be found 
to depend in a great measure, upon this circumstance. 
Patients ought, therefore, to be urged to use them, at 
least as frequently as I have mentioned. When in- 
deed the discharge lessens, or disappears entirely, there 
is no necessity for using injections so frequently, but 
while it continues undiminished, the more frequently 
the remedy is applied to the parts from whence it pro- 
ceeds, the more quickly will it be removed. 

On laying injections aside, even after the running 
has disappeared entirely, and when there is therefore 
cause to suppose that a cure is obtained, the discharge 
often returns with equal seventy as at first, either from 
excess in wine, or over exertion in bodily exercise. 
In such circumstances the injections must again be em- 
ployed, and used with as much frequency as before, 
care being taken not to leave them off till some time 
after the running has again disappeared. 

When the discharge returns repeatedly it is apt to 
weaken and relax the parts so much, that this alone 
comes at last to constitute a new disease, forming a 
variety of what in general is termed gleet. This, how- 
ever, requires remedies of a different kind, and will 
fall to be considered in a different chapter. 



68 OF THE FIRST STAGE Cb. II. 

It will be remarked that I have only slightly taken 
notice of any other remedies in treatment of Gonor- 
rhoea : I have purposely done so, from full conviction 
of the inefficacy of ail remedies that are not immediate- 
ly applied to the urethra, and from finding that a 
proper use of injections never fails to prove successful, 
where a cure by any means can be obtained. 

Where much pain and inflammation takes place, I 
have observed above that some advantage may be ob- 
tained from blood letting, and a strict attention to an 
antiphlogistic regimen. I think it right, however, 
to say, that few cases occur in which this becomes ne- 
cessary. A patient under Gonorrhoea should live 
moderately, but by no means upon such low diet as in 
former times was prescribed in such cases. He ought 
to live in such a manner as may prevent the inflamma- 
tory symptoms from becoming severe, but not so 
low as to run any risk of inducing relaxation or de- 
bility. 

The circumstances which most particularly require 
attention are, abstinence from all manner of connec- 
tion with women, and from bodily exertion, such as 
much walking and riding on horseback, which more es- 
pecially affects the parts concerned in this disease. 

In the treatment of Gonorrhoea, where no injec- 
tions are used, where the disease is either left entirely 
to nature, or treated with demulcents and purgatives, 
a regular progress towards amendment is, for the most 
part, observed in the discharge. The matter from be- 
ing thin, and of a greenish hue, or perhaps of a red 
colour from being tinged with blood, becomes of a 
thicker consistence, tough, ropy, and of a white or 
yellow colour : but. where injections are employed this 
seldom happens. This natural*" process is thereby in- 
terrupted ; and a cure often takes place without any 
change being perceived in the colour or consistence of 
the discharge. 

There are some symptoms which occasionally take 
place in every stage of Gonorrhoea, and which, it might 
be expected, ought to have been more particularly no- 



SeC. IV. OF GONORRHOEA. 69 

ticed here, such* as chord ee, and evacuation of blood 
from the urethra. But these symptoms being attend- 
ed with circumstances requiring a peculiarity of treat- 
ment, quite inapplicable in the ordinary state of Gon- 
orrhoea, and being all of them highly important in 
their nature, a separate section will be allotted for 
the consideration of each of them. We shall now, 
therefore, proceed to consider the second stage of the 
disease. 



On the subject of injections we are sorry to say that we cannot 
agree with the author, as we are confident that in many instances, 
from a careless use of the syringe and want of attention in compres- 
sing the sides of the urethra immediately above the part affected, 
the disease has spread along the whole course of the canal, even to 
the neck of the bladder ; not only protracting the complaint, but 
also greatly aggravating its symptoms, and inducing frequently one 
of its most troublesome consequences, stricture. 

We have heard the same remark made by many physicians and 
surgeons of extensive practice, more particularly by a British sur- 
geon of celebrity, who informed us as early as the year 1804, that 
for the reasons above stated, he had not for several years made use 
of injections, and had employed as a substitute the Calx Hydrargyi 
alba, and furnished us with the following prescription: 

R, Calx : Hydrarg : Alb : 

Uol : Armen : aa grs. x. 

Mel : Despumat : ^ji. — tere : simul in mortar : marmor : lit fiat linamentum. 

This furnishes a linament of the consistence of the honey itself, 
and is applied by means of a bougie, directly to the part affected, by 
dipping it in the linament about an inch, sometimes more, sometimes 
less, according to the nature and extent of the case, and introducing 
it into the urethra about the same distance, rolling the bougie two 
or three times round in the part, so as to leave as much of the lina- 
ment behind as possible. This operation is repeated five or six 
times for the first two or three days, during which time the running- 
is considerably increased in quantity; the re-petition of the linament 
is then gradually diminished; till the running ceases altogether, 
which it sometimes does in three days, often within the week, and 
seldom exceeds a fortnight. 

We have used this prescription exclusively, for eight years, and 
have not as yet known it fail in a single instance, nor have we ever 
met with a single case of stricture, in any of our patients, who had 
confined themselves to this application. It has obviously one advan- 
tage over injections, that of remaining a much longer time in con- 
tact with the diseased part, which it must do, from its consistence, 
and from which circumstance it requires to be less frequently re- 
peated. 



70 OF THE SECOND STAGE Ch. 



11. 



We have not used the oxymuriate of mercury internally our- 
selves, in this complaint, but are assured by some of our friends 
that they have employed it with great success, and that a mechanic 
of this city who is noted for his skill in curing this complaint, uses 
this medicine solely. 
Vid: Parrs. Mel : Diet : Art : Gonorrhoea, Thatcher's Dispensatory, 2nd edit. 

Of the muriate of gold as a remedy in this complaint, we shall 
speak hereafter. Ed. 

SECT. V. 

Of the Second Stage of Gonorrhoea. 

IN this stage of the disease all the symptoms are 
more violent than in the first. The heat of urine is 
much more severe ; the whole body of the penis be- 
comes tender, and even painful ; and chordee takes 
place to a very distressful degree. The matter dis- 
charged from the urethra is either of an ugly green 
colour, or deeply tinged with blood, and commonly 
very foetid. It is found, on examination, to proceed 
from the more superior parts of the urethra, general- 
ly from about the middle of the perineum, where the 
patient complains of a smart pain upon pressure, and 
where one or more small tumours are often perceptible, 
produced by the inflammation having extended to 
Cowper's glands. 

Although the symptoms of the first stage of Gonor- 
rhoea are commonly very distinctly marked, yet they 
frequently proceed to, and terminate in one of the 
other stages of the disease, particularly in this which 
we are now considering. This happens from the in- 
flammation extending along the urethra, either from 
the matter producing the disease being more than 
usually acrimonious ; from the effect of improper man- 
agement on the part of the patient ; from the impru- 
dent use of irritating or very astringent injections ; or 
from the patient being of a habit of body rendering 
him particularly liable to be acted upon by causes apt 
to excite inflammation. 



Sect. V. OP GONORRHOEA 71 

I conclude that it happens most frequently from the 
first and last of these causes, or, perhaps, from a com- 
bination of them both; as in a great proportion of cases 
of this second state of the disease we find it taking 
place almost from the first day on which the running 
appeared. It must, no doubt, have fallen under the 
observation of every practitioner that this, as well as 
the third and fourth stages of Gonorrhoea, are often 
induced by the patient living in a state of riot and de- 
bauchery, and, in some cases, by the immoderate use 
of irritating injections. But although these are cir- 
cumstances which in every case of Gonorrhoea ought 
to be rigidly guarded against, from their tending to 
excite one of the most distressful complaints to which 
the human species is liable; yet I am convinced, from 
what has been mentioned, that the worst states of the 
disease will frequently occur, notwithstanding all 
that can be done either on the part of the patient or 
surgeon to prevent them. 

As the practice in this state of Gonorrhoea is materi- 
ally different from what we have recommended in 
the fust stage of it, the utmost attention becomes ne- 
cessary in distinguishing between them. In the first 
the matter is, for the most part, discharged from 
within an inch and a half of the extremity of the penis ; 
and where the disease does not extend farther up the 
urethra, although the ardor urinse is sometimes con- 
siderable, yet the pain is never so severe as that which 
arises from the inflammation in the second stage of the 
disease. In this last, the whole body of the penis, as 
we have observed above, is tender and painful ; the 
chordee which takes place is highly distressful, and 
one or more inequalities, accompanied with pain on 
pressuse, are discovered in the perineum : whereas, 
in the former, any chordee which occurs is for the 
most part very moderate. The pain is considerable 
at all times when the patient is not passing water, and 
no hardness or inequalities are perceived in the peri- 
neum. 



72 OF THE SECOND STAGE Oh. II. 

It is proper to remark, that even in the second stage 
of the disease, these glandular tumefactions in the pe- 
rineum are not always at first obvious; but upon 
pressure with the fingers they are easily discovered, 
even on their first commencement ; and in the more 
advanced stages of the disease they become perceptible, 
both to the touch and to the eye. Whenever chordee 
occurs in a severe degree, the whole penis acquires a 
firmness and tension, particularly where it runs along 
the perineum. This, however, is very different 
from the glandular affections to which I allude: the 
one is a diffused swelling, extending over the whole, 
or a considerable part of the penis; it does not con- 
tinue fixed or permanent, and seems to depend upon a 
morbid irritability in the muscles of the penis, by 
which they are easily excited to violent and unequal 
contractions. The others are, at first, small, circum- 
scribed swellings, painful to the touch, which do not 
rise and fall speedily, and which remain more or less 
permanent according as the symptoms with which 
they are connected are more or less violent. 

These swellings proceed, as I have already observ- 
ed, from an inflamed state of Cowper's glands, induced 
by the inflammation extending along their ducts, 
which terminate in the urethra, to the glands them- 
selves. 

Inflammation here, when it comes to a height, in a 
manner similar to what ensues from it in other parts, 
is very apt to terminate in suppuration ; and as the 
formation of matter in the substance of these glands is 
apt to excite the most distressful consequences, nothing 
should be omitted that can tend to prevent it. When 
matter forms in them, if it be not immediately dis- 
charged by an external opening, it is very apt to 
burst into the urethra, and to produce runnings, which, 
in some cases, do not terminate but with the life of 
the patient. 

On the first approach, therefore, of this second stage 
of Gonorrhoea, all our endeavours should be employ- 
ed to remove or lessen the inflammation. If the pa- 



SeC. V. OF GONORRHOEA. 73 

tient is plethoric he should lose a considerable quantity 
of blood with the lancet, and ten or a dozen leeches 
should be applied to the pained part. Whatever his 
habit of body may be, the application of leeches 
should not be omitted, and they ought to be repeated 
once and again, according to their effects, and to the 
degree of inflammation and swelling which take place ; 
saturnine poultices should be applied over the part af- 
fected, the bowels should be kept open with gentle 
laxatives, and the patient should be put upon a low, 
cooling diet. 

If, either by the violence of the inflammation, or 
by an imprudent use of astringent injections, a stop has 
been put to the discharge, much advantage will be de- 
rived from our soliciting a return of it. This however, 
must not be done with applications of an irritating na- 
ture, such as bougies, and stimulating injections, as 
some have advised, but it may be attempted with safety 
by throwing up, from time to time, injections of 
warm oil and other emollients, such as warm decoc- 
tions of lintseed and althea. 

But although we find from experience that much 
harm is done by the application of stimulants directly 
to the urethra, we know that they may be applied to 
the skin both with safety and advantage. Thus, 
when the swelling does not soon lessen, by blood-let- 
ting and the other remedies mentioned above, I have, 
in different instances, derived advantage from the ap- 
plication of blisters to the parts affected, and by cover- 
ing the bites of the leeches with adhesive plaster; this 
practice may be adopted even the day after they have 
been applied. The blister should be made to cover 
the whole perineum. 

When the remedies we have advised are tirr.eously 
and properly applied they will not often fail to re- 
move the inflammation; but when this is not accom- 
plished, and when the swelling or swellings proceed 
to a state of suppuration, nature should be as much as 
possible assisted by a frequent and free use of emollient 
poultices and fomentations ; and as soon as a fluctuation 

10 



74 OF THE SECOND STAGE Cll. II. 

of matter is discovered, it ought to be discharged by 
an opening made the full length of the tumour. In this 
manner a sore will be produced that will be difficult 
to heal ; but if the habit of body be sound, a cure will 
be obtained at last, and there is no other method with 
which I am acquainted that will so readily prevent the 
matter from bursting into the urethra. 

When this unfortunate circumstance takes place, of 
matter collected in one or more of these glands, find- 
ing access to the urethra, scarcely any advantage is to 
be derived from art in the treatment of it. Injections, 
as we remarked in the last section, instead of proving 
serviceable, rather do harm. They cannot reach the 
cavity of the gland, where alone they might prove 
useful, and by preventing for a time that free dis- 
cbarge of matter, which, in every abscess is desirable, 
they cause it to collect, and alternately burst out, in 
greater quantities than before. 

When the cause of such an occurrence is not sus- 
pected, both the patient and practitioner are apt to 
imagine that it proceeds from the fault of the injection : 
every variety of the remedy is therefore employed, 
but nearly the same effect results from all of them, 
and the patient, after being teased and perplexed for 
a great length of time, finds himself in no degree bet- 
ter than he was at first. 

By some practitioners a course of mercury has been 
advised in this state of the disease, and particularly 
frictions with mercurial ointment on the perineum ? 
but although I have often seen the practice fairly and 
completely tried, I never knew any advantage derived 
from it. Neither does mercury prove useful in the 
sores whirl] ensue from opening abscesses in the perin- 
eum, proceeding from Gonorrhoea. On the idea of 
these sores being of the same nature with such as suc- 
ceed to buboes in Lues Yenerea, mercury is commonly 
prescribed ; hut although I have known it repeatedly 
used, not only for the cure of these sores, but for the 
discussion of the previous tumefaction of the glands, J 
never knew any evident benefit derived from it. 



SeC. V. OF GONORRHOEA. 75 

All that in such circumstances can with propriety 
be done is, to cause the patient to live in such a man- 
ner as will most effectually brace his constitution ; his 
diet ought to be of a nourishing; kind ; cold bathing, 
particularly in the sea, proves sometimes useful, and, 
in some instances, Jesuit's bark, in large quantities, 
is given with advantage. 

In no period of this state of Gonorrhoea are injec- 
tions admissible, and I suspect that the discredit into 
which they have fallen with many is owing to their 
being employed promiscuously in every state of the 
complaint. We have just seen that they cannot be 
used with any prospect of success, when suppuration 
has actually taken place, and a very little attention 
will make it appear that they ought not to be advised 
during the inflammatory state of the complaint. While 
the parts are inflamed, instead of endeavouring to re- 
move the discharge, we ought rather to try to promote 
it. Nothing tends with such certainty to moderate 
all the symptoms; and I have repeatedly observed 
that they are all rendered much more severe by what- 
ever tends, in any degree, to give a check to the run- 
ning. It is proper, therefore, that the younger part 
of the profession be put strictly on their guard against 
the use of injections in every period of this stage of 
Gonorrhoea ; a practice which, in the first stage of the 
disease, is the only remedy, as we have seen, upon 
which any dependence ought to be placed, but which 
in this is evidently fraught with danger to the patient, 
and therefore with discredit to those who advise it. 

Besides the glandular abscesses of these parts, which 
we have just described, collections of matter are apt 
to occur in this state of the disease, not only in the 
cellular substance of the perineum, but in the corpus 
cavernosum of the penis, as well as in the corpus spon- 
geosum urethra?. The treatment of these, however, 
ought to be so exactly what we have pointed out for 
the others, that nothing farther need be said upon it. 
To prevent, as much as possible, the risk of such col- 
lections bursting into the urethra, the matter should 



76 OF THE SECOND STAGE Ch. II. 

be discharged by a free opening the whole length of 
the tumor, as soon as it is found to be completely form- 
ed. 

When collections of matter in these parts, whether 
seated in Cow per' s glands, or in the contiguous soft 
parts, terminate, as they sometimes do, in external 
openings, at the same time that a communication is 
formed with the urethra, the urine escapes at the sore, 
and thus another disease is produced, termed a sinus, 
or fistula in perineo. This falls to be treated like 
sinuses in every other part : the seat of the abscess 
must be laid open from one end to the other, and by 
enlarging the .opening in the urethra, if the patient be 
otherwise in sound health, a cure will, for the most 
part, be obtained, by endeavouring to heal the sore 
liom the bottom in the usual way.* 

It may be aile(*ged, if this proves successful where 
the matter has already formed an opening, both in- 
wardly and outwardly, for itself, that a similar prac- 
tice should be adopted where the abscess has only 
burst into the urethra. That a free incision should be 
made into it, and a cure, attempted in the manner we 
have ai ready advised. 

Where the opening into the urethra is such as to 
admit the u: ine to pass into the abscess, the practice 
to which I allude ought undoubtedly to be adopted, 
for no other will prove successful, and the patient 
must remain in a state of great distress and misery 
while this continues ; but while the external tegu- 
ments remain entire, and while the urine does not find 
access to the abscess, no attempt of this kind ought to 
be made. However inconvenient the discharge of mat- 
ter from the urethra may be, and however long it may 
continue, the patient ought rather to submit to it than 
to the uncertain event of a fistulous opening, which al- 
ways proves tedious and distressful, with whatever 
judgment the disease may be afterwards treated. 

* V. System of Surgery, chap, xv. 



SeC. VI. OF GONORRHOEA. .,7,7 

SECT. VI. 

Of the Third Stage of Gonorrhoea Viruknla. 

IN this stage of Gonorrhoea, along with ardor urinae, 
and the other ordinary symptoms of the disease, the 
patient complains of a severe fixed pain in the upper 
part of the perineum, accompanied with a sensation of 
fullness, and tension in all the parts contiguous to the 
anus. The desire to void urine is more frequent than 
in either of the two preceding states, and it is com- 
monly passed with much pain and difficulty; often 
drop by drop. Tenesmus, or a painful and frequent 
desire to go to stool, often takes place, and, in some 
instances, to such a distressful height, as adds greatly 
to the misery of the patient. 

Even in the commencement of tfee disease the pain 
in making water is in some cases so severe as to excite 
heat and other symptoms of fever ; and, in the more 
advanced stages of it, I have known the fever rise to 
a very alarming height. This state of Gonorrhoea, in 
some instances, proceeds from the inflammation spread- 
ing backward in a slow, gradual manner, from the 
point of the penis, which we have shewn to be the 
seat of the first stage of the disease, but more frequent- 
ly it takes place suddenly either from the imprudent 
use of injections, from the patient being in a riotous 
course of life, or from his being exposed to violent ex- 
ercise, either on foot or on horseback. 

On examining the parts affected, the penis is, for 
the most part, in a state of tenderness and irritability, 
nearly indeed, as we have described it to be in the 
second stage of this disorder ; but, together with this, 
on compressing the parts about the end of the rectum 
a sense of pain arises, which is never experienced in 
either of the states already described, and on intro- 
ducing the finger into the anus, the prostate gland is 
found considerably swelled, and in such a state ot irri- 
tability that it can scarcely bear to be touched. 



78 OF THE THIRD STAGE Ctl, II. 

Even the slightest degree of this affection excites 
much uneasiness, and the desire to pass water seldom 
ceases for above a few minutes together ; but when the 
disease has been of long duration, the prostate gland, 
which nearly surrounds the urethra, or which rather 
appears, as it were, to form the passage of urine at 
this part, becomes often so much swelled as nearly to 
obstruct the discharge of urine as completely as when 
the urethra is entirely stopped. Those, indeed, not 
versant in this branch of practice are apt to mistake 
this affection for strictures in the urethra ; # of course a 
delay takes place in using the proper remedies, and at- 
tempts which are frequently made to overcome the 
supposed strictures, too often do mischief. Frequent* 
ly, indeed, neither a bougie, nor catheter, when em- 
ployed for removing a suppression of urine, proceed- 
ing from this cause, can be passed ; for the gland is in 
some cases so much swelled as to obliterate the passage 
almost entirely, and in others, by swelling on one side 
only, the passage is thrown altogether over to the 
other ; circumstances which render the introduction of 
a bougie either impracticable, or at best difficult and 
uncertain. 

As it is in the commencement only of this affection 
that any material advantage is derived from the inter- 
ference of art, and as it is a disease which, in the 
more advanced states of it excites the greatest possible 
distress, we ought instantly on the first approach of it, 
to apply such remedies as experience has proved to be 
the most effectual in removing it. 

Of all the remedies that I have ever employed, ear- 
ly blood-letting is almost the only one from which any 
obvious advantage has been derived. It ought to be 
advised immediately on the first approach of pain, nor 
should we be deterred by a weakly or delicate consti- 
tution. In a person of this description the evacuation 
ought no doubt, to be more sparingly administered 
than where plethora takes place ; but even in the 
most delicate habit of body, a quantity of blood should 

* Vide Strictures. 



SeC. VI. OF GONORRHOEA. 79 

be discharged in proportion to the strength of the pa- 
tient, in the first place by the lancet, and afterwards 
by leeches applied to the parts affected. The prac- 
tice of blood-letting I consider to be equally necessa- 
ry here as in cases of pleurisy ; in the latter, indeed, 
the life of the patient is in greater hazard, but in 
this his future comfort and enjoyment of life are at 
stake. It ought not, therefore, in any instance, to be 
omitted. 

I speak the more decidedly upon this from various 
instances having fallen within my own observation, of 
the most distressful consequences taking place from 
this remedy having been omitted, and from many 
others having ended easily where it was employed 
with freedom. It is in the first stages only of the 
disorder, however, in which it acts with much ad- 
vantage ; chiefly, indeed, on the first symptoms of 
inflammation taking place, for when the prostate gland 
becomes swelled and inflamed in any considerable de- 
gree, neither this nor anv other remedv can be de- 
pended upon for removing it. After a long course of 
time, an enlarged prostate will sometimes be found 
much diminished, but this happens more frequently 
without our being able to account for it, than as a 
necessary consequence of any medicine employed 
for it. 

Blisters do not afford that relief here that we some- 
times derive from them in swellings of Cowper's 
glands, neither is much advantage ever obtained from 
saturnine applications. Opium, whether given by the 
mouth, or in clysters, proves more useful than any 
other remedy for removing the pain and lessening the 
irritation; but probably from coming more directly 
into contact with the diseased parts, it proves evident- 
ly most successful when given in clysters, and it seems 
to answer better in small doses, frequently repeated, 
than in large quantities given at once. Thirty drops 
of laudanum, mixed with two ounces of thin starch, and 
thrown easily into the rectum, very commonly gives 
immediate relief, and as long as this dose proves ef- 
fectual it ought not to be increased, 



80 OF THE THIRD STAGE Ch. II. 

While opiates, given in this manner, lessen the irri- 
tability of the organs of urine, they also give much re- 
lief by removing that painful and frequent desire to go 
to stool, with which patients in this disease are often 
afflicted. 

Hitherto I have said nothing of the use of injections, 
which are frequently employed in this, as in other 
stages of Gonorrhoea, for removing the running. This, 
however, is a practice that ought by no means to be a- 
dopted. It has at first been gone into without reflect- 
ing upon its tendency, and afterwards persisted in mere- 
ly from having once been adopted. In the second stage 
of Gonorrhoea I had occasion to remark that the dis- 
charge, instead of being stopped, ought rather to be 
encouraged. The same observation applies still more 
forcibly here, where a stoppage of the running tends 
always to aggravate every symptom, and where we 
find considerable relief often obtained by our bringing 
on a return of it. This, as we observed in the last 
section, should rather be done by the use of warm 
emollient injections, than by such as stimulate and 
give pain. These, I know, are advised for this pur- 
pose, but as I have known them evidently do much 
harm, even when managed in the most cautious man- 
ner, and as we find, indeed, that the disease is often 
at first induced by this very practice, I do not hesitate 
to say that it ought very universally to be laid aside. 
For a similar reason bougies ought never to be employ- 
ed here. 

Emollient injections prove useful not merely by so- 
liciting a more plentiful discharge from the urethra, 
but by soothing the irritability in the parts affected, 
and thus lessening the pain : and where opiates are 
conjoined with them they act still more powerfully 
in this manner. An infusion of the heads of poppies 
and althea root, used warm, answers particularly well 
for this purpose. Warm poultices, applied external- 
ly over the fundament and perineum, also prove use- 
ful. Some advantage too is derived from warm fo- 
mentations ; and I have known the warm bath afford 
much relief 



SeC. VI. OF GONORRHOEA. 81 

All these remedies, however, act as palliative on- 
ly ; by their use the present distress may be much 
mitigated, while nature, in the course of time, aided 
by cautious management on the part of the patient, 
may at last accomplish a cure. At least, this, in the 
course of my observation, has happened in several in- 
stances where the swelling of this gland has not arriv- 
ed at any great height; but it has been more frequent- 
ly the consequence of rigid attention to regimen than 
the effect of medicines. We constantly find, in this 
complaint, that whatever excites much heat of body 
does harm ; whether bodily exercise, or heating food 
and drink ; hence every thing of this kind should be 
avoided, particularly much walking and riding on 
horseback ; and full meals of animal food, especially 
when wine or other strong drinks are likewise indulg- 
ed in. The diet should consist of milk and vegetables, 
with no greater proportion of animal food than is ne- 
cessary to support the strength of the patient. 

Such drinks should be chiefly used as tend to blunt 
the acrimony of the urine, and to sheath the parts which 
it passes over ; such as infusion of lintseed and althea, 
emulsions of almonds, and water in which gum arabic 
is dissolved. 

I have insinuated that I have little confidence in the 
activity of any medicine for removing swellings in the 
prostate gland, when it has unfortunately acquired a 
considerable bulk. A deference to the opinion of 
others requires that I should state the grounds upon 
which this opinion is formed ; this I shall do in notic- 
ing shortly the medicines which have been employed 
with the view of obviating this complaint. 

AVhen other remedies fail, and in some cases even 
before they are fairly tried, mercury is, in ordinary 
practice, recommended ; but I have much reason to 
think that it very commonly, if not always, does harm. 

Even in early practice I had frequent opportunities 
of seeing this complaint, and being led by conversa- 
tion with others to expect substantial relief from mer- 
cury, I used it freely for several years : I must ac- 

11 



82 OF THE THIRD STAGE Ch. II. 

knowledge, however, that I never perceived any ad- 
vantage arise from it, while, in some cases, evident 
mischief was the effect of the practice. 

Mercury never had any obvious effect in diminish- 
ing the tumour, and by increasing the irritability of 
the system, even when given in small quantities, and 
in the most cautious manner, it usually rendered the 
parts affected more painful than they were before. On 
these accounts mercury appears to be not only an use- 
less but a dangerous remedy so that I have now, in 
swellings of this gland, laid it entirely aside. 

Cicuta has also been much recommended in swel- 
lings of this gland ; but although I have given it very 
full and complete trials, I am not sure that in any in- 
stance it ever proved useful. The disease, in some, 
has appeared to yield while cicuta was employed, but 
this was only where a great length of time had elaps- 
ed, and not in a greater proportion of cases than where 
this remedy was never used. But as it may be em- 
ployed under proper management without any risk to 
the patient, where other remedies do not succeed, and 
where it is necessary to be doing something, it may be 
proper to give it a farther trial before any final opinion 
is formed of it. 

Having, in tumours of other parts, observed obvi- 
ous advantages from a decoction of the root of mezere- 
on, I have, in various instances, used it in swellings of 
the prostrate gland. In some it has appeared to prove 
useful, but never so evidently as to enable me to speak 
with certainty about it. When conjoined with sar- 
saparilla*, it seems, in other cases, to be rendered still 
more active, and the mucilage contained in that root, 
by blunting the acrimony of the mezereon, renders it 
both more agreeable to the palate and more grateful 
to the stomach. 

Among other remedies employed in swellings of the 
prostate gland, sea bathing and drinking sea water 
has been one of the most frequent. Where this dis- 

* Vide Appendix, No. 45. 



Sec. VI. OF GONORRHOEA. 83 

ease is connected with a scrophulous constitution this 
remedy certainly proves useful. It will never remove 
the tumour speedily ; but, by strengthening the con- 
stitution, it seems, in such circumstances, lo render the 
swelling less permanent than it usually proves to be 
where this remedy is not employed. It ought, how- 
ever, to be remarked, that all strong purgatives do 
much harm. This happens in every stage of Gonor- 
rhoea, but especially where the prostate gland or blad- 
der are affected. By the irritation which they excite 
they not only induce a more copious discharge, but 
render the inclination to void urine much more fre- 
quent and more painful. When salt water is used, 
therefore, it ought not to be in greater quantities than 
will answer as very gentle laxatives. 

Swelling of the prostate gland does not terminate 
as tumours in the other glands of the urethra frequent- 
ly do, in suppuration. When Cowper's glands, or 
any of the smaller glands of the urethra become in- 
flamed, they either suppurate or a cure is obtained by 
discussion : but, in similar affections of the prostate 
this very seldom happens. When the tumour does 
not yield to timeous blood-letting, or when it does 
not afterwards crraduallv subside, it either remains 
nearly of the same size and hardness, or becomes both, 
larger and firmer till it ends in real schhrus, of con- 
siderable magnitude. 

In this state of the disease the discharge is, for the 
most part, thin and acrid ; together with matter from 
the contiguous parts of the urethra, which are usually 
more or less diseased, a considerable quantity is thrown 
out of the gland itself, forming, as we will afterwards 
see, one of the most obstinate varieties of gleet. 

Even in the commencement of this affection of the 
prostate, the passage of urine, as we have already re- 
marked, is often much obstructed; but, in the more 
advanced stages of it, this, in some cases, comes to 
such a height as to be insurmountable. Whether 
from the passage being completely obliterated by the 
sides of the swelled gland adhering together, which is 



84 OF THE THIRD STAGE CI). II. 

alledged lo happen, but which T never saw, or from 
the passage being contracted by the sides of the gland 
swelling unequally, it sometimes happens that neither 
a bougie nor catheter can be introduced. In this case, 
as a total obstruction is formed to the passage of urine, 
we are obliged to draw it off by puncturing the blad- 
der, which may either be done above the pubes, or by 
passing the trocar into the bladder from the rectum, 
or pushing it up by the side of the diseased gland.* It 
must be remarked, however, in forming an opening 
with a trocar for drawing the urine off from the blad- 
der, that a very enlarged state of this gland precludes 
every attempt for this purpose either in the perineum 
or rectum. In which case it must necessarily be done 
above the pubes. 

In such circumstances, all that art can do, is to pre- 
serve a passage for the urine, by retaining a canula in 
the opening, and keeping the patient as free from pain 
as possible with doses of opium adequate to the distress 
T in which he happens to be. 

* Vide System of Surgery, chapter xiii. 



The author observes in the commencement of the section, that a 
swelling of the prostate gland may be mistaken for a stricture 
in the urethra, and a dangerous delay in the use of remedies 
will- be the consequence. The following distinction Mr. Home 
observes 1 , will occur between the two diseases. Let a soft bougie 
be introduced into the urinary canal as far as possible and per- 
mitted to remain for a minute or two until it can receive an impres- 
sion from the obstruction. If it does not pass farther than seven 
inches, and the end is marked by an orifice of a circular form, the 
disease is a stricture, but if it passes farther and the end is 
blunted, the prostate gland is probably affected. In addition to 
the symptoms mentioned above, may be added the flattened stool, 
which is indeed a diagnostic of a diseased prostate. 

Most of the remedies which prove useful in a swelling and 
enlargement of this organ, have been enumerated, and in most 
cases a correct opinion is given. Gentle laxatives are perhaps 
improperly omitted, as they are useful in diminishing irritation.. 
The warm sea bath is considered by some writers, as of more 
importance than the author is willing to attach to it. When the 
inflammation is subsiding, and there is danger of a permanent en- 



Sec. VII. OF GONORRHOEA. 85 

largement, it has been found by many practitioners, in opposition 
to the experience of Mr. Bell, that mercury is a valuable medi- 
cine in reducing the gland. 

" As to schirrous enlargement" says Mr. Samuel Cooper " no 
certain mode to diminish it is known to surgeons." He mentions 
however the Pilule Hydrargyri cum cicuta* as a useful remedy, 
Mr. Home states a case in which suppositories of opium and 
hemlock were introduced per ano, and allowed to be dissolved there. 
They allayed the irritation, as well as diminished the size of the 
gland. 

When it becomes necessary to puncture the bladder, it is advisa- 
ble, if possible, to do so through the coats of the rectum. This is 
the opinion of the most distinguished surgeons of the present day. 
^Nothing but an enormous enlargement of the gland need prevent it, 
" and in a case," says Charles Bell, " of the largest gland I ever 
" saw, I still prefer the attempt to puncture by the rectum, for I 
" conceive it still to be practicable while we can feel any part of 
••' the bladder." Operative Surgery, Vol. 1. Chap. 4th. 

*R. Hydrargyri purificati X\ 

Gummi Mimosa miotic ae pulverisatse Xi 
Succi Cicutae spissati Zi 
Herbae cicutae fbliorum, in pulverem 
Tritorum q : s : 

Triturate the quicksilver, with the gum arabic moistened with a 
little rain water. Then add the inspissated juice, and lastly the 
powdered leaves, in sufficient quantity to make a suitable mass for 
pills. Cooper's Surgical Dictionary. 

Ed. 

SECT. VII. 

Of the Fourth Stage of Gonorrhoea. 

IT sometimes happens that the inflammatory symp- 
toms pass easily over the anterior part of the urethra, 
and shew themselves in more force and violence high- 
er in the passage. Thus, although the third stage of 
the disease, in which, as we have seen, the prostate 
gland is chiefly affected, is sometimes produced by 
the inflammation spreading from those parts which are 
only concerned when the second stage of it takes place, 
yet instances often occur of the inflammation passing 



86 > OF THE FOURTH STAGE Ch. II. 

from the point of the urethra along the whole course 
of the passage, without any intermediate part of it 
being much affected, and fixing in the most violent 
manner, upon the prostate gland or bladder. In 
some cases the prostate is affected while the bladder 
itself remains sound, while in others it passes easily 
over that gland, and seizes with much violence upon 
every part of the bladder. 

In some cases the bladder becomes affected almost 
on the first attack of the disease. The inflammation 
spreads so quickly alon^ the urethra that the bladder 
is pained in the course of a few hours from the com- 
mencement of the discharge. It more frequently oc- 
curs, however, after the running has been of some 
duration, and, for the most part, can be traced as the 
consequence of much exposure to cold and dampness ; 
of violent exertion in walking or on horseback, or, as 
the effect of an injection thrown with too much vio- 
lence into the upper part of the urethra. 

The patient, from the first approach of the disease, 
complains of much uneasiness, which at last termi- 
nates in severe pain over all the region of the bladder, 
particularly about the neck of it; accompanied with 
a frequent and painful desire to make water, and of- 
ten with tenesmus. In some cases the pain is chiefly 
seated about the anus, but, in general, all the under 
parts of the abdomen, particularly about the region 
of the pubes, are greatly pained, and in some instan- 
ces, even the kidneys become affected, either from 
nervous sympathy, or from the inflammation spread- 
ing from the bladder along the ureters. 

In general the pain, especially after voiding urine, 
extends to the glans penis, and as this, with the stop, 
page which occurs to the flow of urine, are symptoms 
which always accompany stone, cases of this kind, 
when the history of the disease has been concealed, 
has been mistaken for stone in the bladder. 

If the running from the urethra has not been stop- 
ped by injections, it continues as if no affection of the 
bladder had occurred ; and in geneial any interrupt 



Sec. VII. OF GONORRHOEA. 87 

tion that takes place to the discharge proves only tem- 
porary ; but along with the usuai running from the 
urethra, such as takes place in one or other of the dif- 
ferent stages which we have described, a considerable 
quantity of matter passes off with the urine. This 
gives the urine a turbid appearance, as if purulent 
matter was mixed with it, but on examining the depo- 
sition, which is usually made in the course of a few 
hours, it is found to consist almost entirely of mucus. 

On a further continuance of the disease this matter 
contained in the urine assumes a very different appear- 
ance. Instead of being broken and divided into flakes, 
as at first, it now becomes tough and viscid, in a very 
remarkable degree, resembling isinglass diluted with 
water to the consistence of jelly. This gelatinous 
matter is suspended in the urine when first voided, but 
it soon separates, and falls to the bottom, where it 
adheres so- firmly to the sides of the vessel in which it 
is received, as to be separated from it with difficulty. 
In some cases this substance is clear and transparent, 
but. for the most part, it is tinged of a yellow hue, 
and somewhat opake. 

When any considerable quantity of this matter has 
passed off; the patient is commonly relieved, and con- 
tinues easy for a longer or shorter period, according to 
the degree of inflammation that takes place. 

In some cases the quantity of this viscid matter is 
very inconsiderable, being no more than what slight- 
ly covers the bottom of the pot, while in others it 
seems to form more than half of all that comes from 
the bladder. When in such considerable quantities, 
it tends greatly to reduce the strength of the patient, 
insomuch that few constitutions are able to bear it 
long. 

From the nature of the parts in which this disease 
is seated, we would expect that it should be the most 
formidable complaint that Gonorrhoea could induce ; 
but this is by no means the case : the disease describ- 
ed in the last section, viz. swelling of the prostate gland, 
proves always more so. Few recover from the one.. 






38 OF THE FOURTH STAGE Ch. II. 

while cures are obtained by a great proportion of all 
who are seized with tire other. At least in healthy 
constitutions this commonly happens, if the disease 
has not been much neglected at first. In general, in- 
deed, a considerable time passes over before a perfect 
cure is obtained ; nay, some degree of uneasiness, and 
certain deranged sensations, will often continue for a 
number of years, but after the first violence of the 
symptoms is over, they generally become, in a gradual 
manner milder, till at last they vanish entirely. 

On the first approach of the disease, blood-letting is 
the only remedy upon which most dependence ought 
to be placed, and, when freely practised, it seldom 
fails to render the symptoms moderate, and of shorter 
duration than they otherwise probably would be. 

A quantity of blood should be taken with the lancet 
in proportion to the strength of the patient, a num- 
ber of leeches should be repeatedly applied to the 
neighbourhood of the anus. With respect to diet, 
and other circumstances, the patient ought to be treat- 
ed in the manner we have advised in the last sec- 
tion. His bowels should be kept moderately open 
with castor oil, or other gentle laxatives, and opiates 
should be exhibited in sufficient doses for lessening, or 
even for removing the pain. When treating of swel- 
ling of the prostate gland we advised opiates to be 
given in the form of clysters, rather than by the mouth, 
and this mode of exhibiting the remedy proves equal- 
ly useful here. 

With a view more certainly to allay the irritability 
of the bladder, it has been proposed to inject opium 
dissolved in water into it, but this appears to be a dan- 
gerous experiment. I have known it done, but the 
patient was nearly killed by it. Convulsions and oth- 
er alarming symptoms occurred, but not in such de- 
gree as to prove fatal. 

W 7 arm emollient injections, such as warm oil, or 
the form of injection in the Appendix, No. 23, fre- 
quently give relief from pain, and give a temporary 
suspension of that constant desire to pass water which 



SeC. VII. OF GONORRHOEA. 89 

often prevails here ; and in some cases the semicupium 
proves successful when these have failed. 

A plentiful use of mucilagenous drink* such as in- 
fusion of lintseed and althea root, and a solution of 
gum arabic in water, afford relief in all affections of 
the urinary passages, but in none more than in the one 
of which we are now treating. 

All these remedies are meant to alleviate pain and 
irritation in the commencement of the disease, and 
when timeously applied, and duly persisted in, they 
very commonly prove effectual ; but in the more ad- 
vanced stages of the disease, when the pain is not so 
severe, but when a good deal of uneasiness continues, 
accompanied with a discharge of that viscid matter 
which we have described, remedies of this kind do not 
afford so much relief. Opiates will no doubt tend at 
all times to allay irritation, by blood-letting, which 
at first never fails to give relief, tends now only to 
weaken the patient, without being productive of any 
advantage. 

In this situation Jesuit's bark sometimes proves use- 
ful; and I have seen instances where a few grains of 
alum added to each dose, seemed to render it more ef- 
fectual. Balsam of copaiba, and Canada balsam, prove 
likewise useful here : but where much benefit is ex- 
pected from them they should be given in as large do- 
ses as the stomach of the patient will permit. 

Of all the remedies, however, which in such circum- 
stances I have ever tried, uva ursi is the most effectual. 
No advantage is derived from it where the prostate 
gland is diseased ; but in unmixed affections of this kind, 
where the bladder only is affected, it seldom fails to 
procure relief. It may be given to the extent of a 
scruple at first, and afterwards half a drachm of the 
powder three times a day, in which quantity it seldom 
fails, in the course of a few days, to lessen the pro- 
portion of viscid matter in the urine; by which, and 
the abatement of pain which at the same time takes 
place, we are always certain that the inflammation al- 
so is diminished. 

]2 



90 OF THE FOURTH STAGE, &C. Cll. II. 

On the idea that this affection of the bladder pro- 
ceeds from a translation of the matter of Lues Vene- 
rea from the urethra, mercury is commonly used in 
it.; but although I have often given it, I never knew 
any advantage derived from it; it sometimes even 
does harm. It increases the irritability of the system 
in general, as well as of the parts more particularly 
afiectedJ 

Wlien affections of this kind have continued long, 
the bladder is apt to become much thickened and les- 
sened in diameter: hence, even after all the other 
svmptoms are gone, the frequent inclination to pass 
urine continues. In some cases this goes on for years : 
nay, I have known it endure for a great length of time, 
and only terminate with the life of the patient. It 
seem3 evidently to be the effect of inflammation, for 
it succeeds to inflammation of the bladder, by what- 
ever cause it may be induced. It also occurs from 
strictures in the urethra, when they happen to be con- 
siderable and of long duration. 

For the removal of this thickened state of the 
coals of the bladder mercury is often prescribed, and 
in some cases it has certainly proved useful ; but it 
seems to prove equally so from whatever cause the dis- 
ease may at first have arisen^. 

* This practice of giving- mercury in the thickened state of the urinary blad- 
der which succeeds to inflammation, we find recommended by the late Doctor 
Ebenezer Gilchrist of Dumfries, to whom we are indebted for much valuable in-> v 
formation in different parts of the practice of medicine. 



The warm bath and opiate clysters, are remedies of great value 
in an inflammation of the bladder. Mr. John Hunter recommends 
an opiate plaster, on the pubes or loins, where the nerves of the 
bladder originate, provided the disease should prove obstinate. Di- 
luents are indispensible, in large quantities, and among these, barley 
-water will be found most useful, Ed» 



Sec. vm. of chordee. 91 



SECT. VIII. 

Of Chordee. 

CHORDEE is a painful, involuntary erection of 
the penis. Patients in every stage of Gonorrhoea are, 
in some degree, liable to Chordee ; but it occurs 
much more frequently and to a much greater height 
in the second stage of the disease, than in any of the 
others. It happens at all times of the day, but most 
frequently when the patient is warm in bed, when 
it is in some instances so severe as to deprive him en- 
tirely of rest. During a fit of Chordee the penis be- 
comes hard and painful to the touch, and for the 
most part it is curved downwards in a considerable de- 
gree. 

Chordee occurs in every period of this stage of 
Gonorrhoea, and it sometimes remains after the heat 
of urine and all the other symptoms are gone, but 
it is usually most severe during the continuance of 
the inflammation, and becomes more or less so ac- 
cording as that symptom is in a greater or lesser de- 
gree. 

I therefore conclude that Chordee is an effect of in- 
flammation, and that it proceeds from irritation, com- 
municated from the nerves of the urethra to those of 
the contiguous muscles, by which those unequal de- 
grees of contraction are produced over the whole 
substance of the penis, which universally take place ia 
this disease. 

Were it owing to effusions of lymph into the re- 
ticular parts of the penis, as some have imagined to 
be frequently the case*, Chordee would be of a more 
permanent nature than we ever find it to be, and these 
effusions would be apt to terminate in suppuration. 
Now, although suppuration is sometimes the conse- 
quence of inflammatory tumours in these parts, I 
have never observed thatit happens in those tumefac- 

* V. John Hunter on the Venereal Disease, 



92 OF CHORDEE Ch. II. 

lions which accompany Chord ee. The latter com- 
monly rise and disappear again in the course of a few 
hours, and they are more diffused than tumours usu- 
ally are which proceed to suppuration. The others 
rise more slowly, and they terminate, whether by 
dispersion or suppuration, in a much more gradual 
manner. 

Of aM the remedies I have ever employed opiates 
prove most useful in Choi dee. The pain and tension 
are sometimes removed by rubbing the parts affected 
with laudanum, or with a strong solution of opium 
in water, and by keeping pledgits immersed in either 
of these, constantly applied to them ; but the greatest 
advantage is obtained from the internal exhibition of 
opium. Thirty or forty drops of laudanum, given at 
bed-time, or on the accession of the Chordee, very 
seldom fails in preventing or removing it. 

Emollient injections thrown up the urethra, particu- 
larly when impregnated with opium, have also a pow- 
erful influence in lessening the violence of Chordee ; 
and as the heat and irritation produced by costiveness 
tend greatly to augment the violence of this symptom, 
I have known much advantage obtained from the ope- 
ration of a gentle laxative. 

A temporary relief is often derived from the ap- 
plication of a cold solution of saccharum saturni and 
I have known the external application of camphor 
prove serviceable ; when dissolved in spirit of wine 
it proves useful, but it acts with more advantage 
when dissolved in oil. Frictions with mercurial oint- 
ment have been much recommended for the removal 
of Chordee, but as I have commonly found more ad- 
vantage from rubbing with camphorated oil, I conclude 
that it is chiefly the emollient properties of the mercu- 
rial ointment which render it useful, and, therefore, 
that the inconveniencies which sometimes occur from 
mercury, may here be avoided. 

In some cases we derive advantage from tying the 
penis down with a fillet to the thigh, but it only an- 
swers in very slight affections, and the practice ought 



Sect. VIII. OF CHORDEE 93 

never to be advised in the more severe attacks of the 
disease. Being an obvious remedy for counteracting 
an erection, it is not unfrequently employed in the 
first instance by the patient; but I have frequently 
known it do harm, either from the fillet being appli- 
ed too tight, or from the parts being in such a state of 
tenderness as to render it altogether inadmissible. 

When none of the&e remedies succeed, blood-letting 
sometimes proves useful ; particularly by the applica- 
tion of leeches to the parts affected, nor ought this ev- 
er to be omitted when the patient is of a plethoric hab-; 
it, or when the pulse is full.- When Chordee takes 
place in a slight degree only, blood-letting is never ne- 
cessary ; but whenever it is severe, and resists the oth- 
er remedies we have mentioned, we ought never to hes- 
itate in advising it. Blood-letting proves more effect- 
ual than any other remedy in preventing that perma- 
nent kind of Chordee, which sometimes continues very 
distressful long after every other symptom of Gonor- 
rhoea has disappeared. 

Opium is one of our most effectual remedies in eve- 
ry stage of this symptom, but particularly where it 
has been of long continuance. In this state of the 
disease I have sometimes found, where opium has 
failed, that henbane, the hyocyamus niger of Lin- 
naeus, has proved useful. A grain of the extract, prop- 
erly prepared, may be given three times a day at 
first, and the dose increased to two, three or more 
grains, according to its effects. I have given to the ex- 
tent of seven and eight grains three times a day, with 
no inconvenience whatever ; but this was after the 
patient had been for some weeks accustomed to the 
remedy. 



<H Or HAEMORRHAGES Ch. II. 

SECT. IX. 

Of Hemorrhages Jrom the Urethra. 

IN the description of the disease, we have seen that 
the matter of Gonorrhoea is frequently tinged with 
blood. When the quantity of blood is inconsiderable 
little or no notice is taken of it, the matter gradually 
acquires the common appearance, and a cure is ac- 
complished in the usual way ; but when a blood vessel 
of any magnitude bursts in the urethra, as sometimes 
happens when the inflammation runs high, such quan- 
tities of blood are discharged as prove highly alarm- 
ing. I have known different instances of three or 
four pounds of blood being discharged in the space of 
a few hours. 

On the first appearance of this symptom, complete 
rest should be immediately recommended, for nothing 
tends more to promote haemorrhages of every kind 
than bodily exertion. The patient's bowels ought to 
be opened with a gentle laxative ; his diet should be of 
a cooling nature ; he ought to be kept in a cool, well- 
aired apartment, and the penis should be immersed-, 
from time to time in a cold solution of cerussa acetata, 
in equal parts of vinegar and water. 

In Haemorrhages of every kind I have derived more 
advantage from a plentiful use of kino, and partic- 
ularly in the symptom which we arq now considering. 
It may be given in the quantity of twenty grains four 
times a day, and it may be used either by itself, or 
rubbed with equal parts of gum arabic and fine sugar, 
which renders it both more palatable and more grate- 
ful to the stomach. 

In some cases I have derived advantage from astrin- 
gent injections ; particularly from an infusion of red 
rose leaves, strongly impregnated with alum, as in 
]NTo. 21, and from No. 14*, of which balsamum co- 

*Vide Appendix. 



See. X. FROM THE URETHRA. 95 

paiba forms tire basis. The injections should be thrown 
up with caution, and retained by compressing the ure- 
thra as long as the patient can bear them. 

When all these means fail, and when there is cause 
to suspect that the patient's life may be endangered 
by the loss of too much blood, recourse must be had 
to pressure. I have, in different instances put an im- 
mediate stop to the discharge by inserting a bougie 
into the penis. When the bougie is large nothing far- 
ther is necessary ; but when it does not prove success- 
ful of itself, if the discharge proceeds from the fore- 
part of the penis, it may be stopped at once by gentle 
pressure with a narrow roller ; when it flows from the 
perineum, by continued pressure with the hand or fin- 

£ ers \ 

With a view to obtain a long continued pressure, a 

catheter of elasticgum may be used instead of a bougie, 
by which the patient may, with due care and atten- 
tion, void his urine while the pressure is continued : 
but if the bladder is emptied immediately before the 
bougie is introduced, it may, for the most part, be re- 
tained as long as is necessary. 

Having in this and the preceding sections consider- 
ed Gonorrhoea in the different forms under which it 
occurs in men, we shall now offer a few observations 
upon the same disease as it appears in females, 



SECT. X. 

Of Gonorrhoea in Women. 

WOMEN are less susceptible of this disease than 
men ; and with them it is also less violent in its symp- 
toms, and less alarming in its consequences. 

Why men should be more readily infected than wo- 
men is difficult to explain ; but that the disease should 
prove more violent in the former is evident. The 
parts which it attacks are more numerous, and more 



•96 OF GONORRHOEA Ch. II. 

deeply seated ; and we find that all the symptoms of 
this disease are mild or severe according as the parts 
affected are deeply seated, or otherwise. Hence, as 
long as the extremity of the urethra only is affected, 
the symptoms of Gonorrhoea are equally violent in 
both sexes. During the continuance of the first stage 
of the disease in men, the pain is never more severe 
than we often meet with it in women, nor does it ever 
become so till the inflammation proceeds to a greater 
depth. 

In women the discharge proceeds either from the 
vagina or urethra, and in some cases, partly from both; 
When the vagina only is affected the pain attending 
it is inconsiderable, unless the matter is so acrid as to 
inflame the clitoris, nymphae, or labia pudendi, as we 
sometimes find is the case; but whenever the urethra 
is the seat of the disease, the same degree of ardor 
urinae takes place as usually occurs in men. Nay, in 
women this symptom is often more severe, and the 
inflammation by which it is produced proceeds more 
readily and more frequently in them to the bladder 
than it usually does in men ; for, in most instances of 
Gonorrhoea in women, they complain of severe pain 
over the loins, and all the region of the bladder, and 
their urine very commonly deposits mucus in such 
quantities as indicates a considerable affection of that 
vise us. 

This must happen from the passage to the bladder 
being considerably shorter in them than in men ; and 
the urethra being wider and not so liable to be ob- 
structed, the symptoms arising from affections of this 
part are neither so severe, nor are they usually of such 
long continuance. 

On examining the seat of Gonorrhoea in women, it 
is often difficult to determine whether the disease exists 
or not, and if the patient is inclined to conceal any 
circumstances connected with her situation, it is alto- 
gether impossible to ascertain this point with precision. 
This uncertainty occurs from the similarity of Gonor- 
rhoea to the matter of fluor albus, a disease to which 
women are so very liable, that, in some degree, scarce- 



Sec. x. is womek. 97 

]y any but the most robust are at all times free of it. 
Besides a similarity in the matter, the heat of urine, 
and inflammation of the contiguous parts, are often 
equally severe in the fluor albus as they commonly 
are in Gonorrhoea. 

The chief distinction which external appearances 
afford between the two diseases, is, that in fluor albus 
the matter is of a whiter colour than in Gonorrhoea. 
In the latter it is somewhat of a cream colour, where- 
as, in fluor albus it is usually of a pale white colour, 
and of a thinner consistence. It must, however, be 
acknowledged, that these means of distinction are by 
no means sufficient, and that no certainty upon this 
point can be obtained but by a full account being re- 
ceived from the patient herself of all the circumstan- 
ces connected with the case. When a woman is seiz- 
ed with heat of urine, and a discharge of matter from 
the parts of generation, and at the same time admits 
that these symptoms succeeded to her connection with 
a man labouring under Gonorrhoea, no doubt will re- 
main of the nature of the disease : but when a patient 
inclines to conceal the real cause of her disorder, no 
means with which we are yet acquainted are sufficient 
to ascertain the difference between these two dis- 
eases. 

It fortunately, however, happens, that the remedy 
which answers with most certainty in the one, proves 
equally powerful in the other : the remedy I allude to 
is an astringent injection. All the variety of injec- 
tions enumerated in the foregoing sections may be used 
with equal propriety here : but it is chiefly the vitriol- 
ic solution, No. 18, upon which much dependence 
should be placed. When duly persevered in, and 
thrown up five or six times a day, it seldom fails, in 
women to accomplish a cure of Gonorrhoea, and it 
proves equally successful, as I have observed above, in 
removing the fluor albus. 

Where, indeed, the constitution is much debilitated, 
and where the discharge is kept up by general relaxa- 
tion of the constitution, although injections may re- 

13 



98 OP GONORRHOEA Ch. lh 

move the running, they will not prevent a return of 
it ; but from much experience of their influence I 
can recommend them a? one of the most powerful 
remedies that has yet been used for this very distress- 
ful symptom, to which a great proportion of the sex 
are liable. 

In females injections may be used with the great- 
est freedom, when the discharge proceeds from the 
vagina ; but in throwing injections up the urethra more 
circumspection is necessary than is even required in 
men. The urethra in women being short, and the 
sphincter of the bladder more ea-ily forced, if injec- 
tions are thrown up with violence, they will readily 
pass into the bladder ; and as this might be productive 
of much irritation and pain, it ought to be carefully 
guarded against. With proper attention this is easily 
done ; and as the running proceeds, for the most part, 
from within half an inch of the extremity of the ure- 
thra, there! is no necessity for throwing injections 
farther. 

Where the disease is entirely confined to the ure- 
thra or vagina a cure may always be accomplished by 
injections; particularly if these be accompanied with 
a proper attention to diet, and to the state of the 
bowels: but where the bladder is already affected, 
other remedies are required. The patient must lose 
blood in quantities proportioned to her strength ; the 
diet should be very low; her bowels should be kept 
easy with gentle laxatives ; and the pain and irritation 
should be lessened or removed with doses of opiates 
proportioned to the violence of these symptoms. 

In women the mucous glands of the parts affected 
are apt to inflame, although not so frequently as in 
men, nor are the consequences which result from them 
so apt to prove permanent. This may happen from 
none of these glands being so large in women : hence, 
when they swell from inflammation, they do not ar- 
rive at such a bulk, and when they suppurate, the ab- j 
scesses which ensue more easily heal. They are 
chiefly situated in the labia pudendi, and in the va- 
gina. 






Sec. x, in woMEtf. 99 

Swellings of this kind in women require the same 
method of treatment as in men. Blood-letting, both 
general and local, should be advised on the first ap- 
pearance of the tumours, and the parts affected should 
be kept covered with a cold solution of saceharum 
saturni in water and vinegar. When this fails in pre- 
venting their increase, warm emollient cataplasms 
should be advised, in order to forward suppuration; 
and this taking place, the tumour should be laid open 
with a free incision from one end to the other. 

AY here tumours of this kind arrive at a larger size 
than usual, I have, in different instances, both in men 
and women, discharged the matter by the introduction 
of a seton. But as setons are not easily managed in 
this situation, the mode of opening them by incision 
should be preferred ; and it will commonly be found 
that it answers best to lay the abscess open through 
its whole length. 

In the treatment of Gonorrhoea in women there are 
some who uniformly prescribe mercury, although they 
never advise it in men. This they do from an idea of 
its being more frequently connected with Lues Vene- 
rea in women than in men. 

I have not found, however, that this is the case, or 
[that there is cause for mercury being given for this 
disease in women more than in men. Gonorrhoea of- 
ten takes place in women as it does in men along- with 
Lues Venerea : in such circumstances mercury must 
no doubt be employed ; but by no means on account 
of the Gonorrhoea. So far as my observation goes, 
the disease is to be cured in both sexes in the same 
manner, chiefly, as I have already remarked, by the 
juse of astringent injections. 

It happens, indeed, in women, as it does in men, 
that Gonorrhoea, particularly the milder forms of the 
disease, will disappear whether injections are used or 
not. This in former times, was attributed to the pur- 
gative, demulcent, and astringent medicines, which in 
all cases were used in large quantities ; but by later 
experience we know that none of these remedies are 



|00 OF GONORRHOEA, &C Ch. II, 

necessary, and that the disease disappears as soon, and 
with as much certainty, where none of them are em- 
ployed, merely by keeping the parts dean, with a 
proper attention to regimen. 

In speaking of cleanliness it is proper to remark, 
that both in men and women it ought at all times to be 
inculcated, particularly in women, where the matter 
of Gonorrhoea is very apt to become acrid, and exco- 
riate the parts to which it is applied. b 

Attention to this circumstance is often advised, oa 
the supposition of chancres being likely to occur from 
the matter of Gonorrhoea, where it is allowed to rest 
long upon any particular spot. Whatever excites at- 
tention to cleanliness will here prove useful ; but no 
practitioner of observation will now admit that the ^ad- 
vantages arising from it proceed from this cause. Were 
this the case, excoriations produced in this manner 
would not heal without the use of mercury; whereas 
we all know, that affections of this kind, proceeding 
from the matter of Gonorrhoea, never require mercu- 
ry, and that they heal easily merely by bathing the 
parts frequently, and preventing the matter from rest- 
ing upon them in future. 



Although repeated instances within our own experience enable 
US to verify the remark of Mr. Bell, that the diagnosis between 
Gonorrhoea and Leucorrhoea is extremely difficult, yet we can hardly 
allow that he has sufficiently distinguished the prominent symptoms 
of each. Fluor albus is a disease of the system, or rather of the 
uterus and vagina affecting the system. Its causes are those which 
in general produce debility and it is commonly found among females 
of lax fibre and a delicate make. The discharge is irregular and 
comes away in some cases in large lumps. Pains in the back and 
loins, loss of appetite and strength, paleness, &c. are among its 
common effects, and it must be added that a heat of urine and in- 
flammation of the pudenda are uncommon symptoms. 

In Gonorrhoea, however? the last mentioned symptoms are among 
the first that occur, but the disease is purely local and the strengt 
of the patient is not affected. In the mode of cure, a dlffereuM 
will also be necessary after a few day's trial Although injections 
as the author justly observes, are proper id both diseases, yetthej 
Will not remove Leucorrhoea, and a resort to tonics will become ne 
ccssarv. Among these, we would particularly recommend th< 




gee. xi. Recapitulation. 101 

Tinct: Oxymuriat: Ferr: But in Gonorrhoea, injections will ef- 
fect a cure, and they may be used with less clanger than in men. 

In medico — legal cases, where the physician is called upon for an 
opinion whether the patient labours under one or the other of these 
diseases, it will be proper, after taking into account the above enu- 
merated symptoms and the character of the patient, to examine the 
effects of the discharge on her linen. In Gonorrhoea, a greenish 
coloured stain is found, whilst in fluor albus, none is perceptible, at 
least very seldom. The character of the parties especially that of 
the women, is in some cases the only thing that can lead to the truth/ 
(Stringham's M. S. Lectures on Legal Medicine.) 

Ed. 



SECT. XL 

Recapitulation. 

I have thus finished the observations I had to offer 
on Gonorrhoea as it appears both in the male and fe- 
male patient; but it may not be improper in this 
place, by a short and general recapitulation, to bring 
the subject into one point of view. 

1. From the arguments stated in different parts of 
the preceding sections it appears that Gonorrhoea is a 
local disease, proceeding from a specific contagion, 
and not necessarily connected with any other. 

2. That the discharge of matter which takes place 
is not the effect of ulceration, but proceeds from an 
inflamed state of the urethra and contiguous parts. 

3. That this inflammation, while confined to the 
membrane of the urethra, particularly to the parts 
near to the extremity of the penis, is never produc- 
tive of any alarming symptom: a discharge of mat- 
ter, accompanied with ardor urinae, and some slight 
degree of Chordee, being almost the only ones that 
take place. 

4. That the disease is always formidable in propor- 
tion to the depth of parts that are affected, the symp- 
toms which occur being more or less violent, and pro- 
ductive of more or less hazard, according as the in- 
flammation has reached to Cowper's glands, the pros- 
tate gland, or to the bladder. 



102 RECAPITULATION. CI). II. 

5. That in (he cure of Gonorrhoea no advantage is 
derived from mercury, or any remedy acting altogeth- 
er upon the constitution. The disease being entirely 
local no medicine proves useful but such as act direct- 
ly upon the parts affected. 

6. That where the membrane of the urethra is alone 
affected, no remedy proves so successful as astringent 
injections.^ 

7. That these injections, in order to act with safe- 
ty and advantage, must be thrown up with much cau- 
tion, and repeated from six to eight or ten times a day, 
at the commencement of the disease ; less frequently 
as the discharge lessens, and at last in a gradual man- 
ner, laid entirely aside. 

8. But although injections of this description may 
be used with safety in all cases of Gonorrhoea where 
the membrane of the urethra only is affected, that 
they are never employed but with much risk of doing 
harm where the inflammation has reached to Cowper's 
glands, to the prostate gland, or to the bladder. 

9. That the greatest attention is therefore required 
in distinguishing between the different stages of Go- 
norrhoea; the want of this having, with some practi- 
tioners, brought the use of injections into discredit, 
when the fault did not lie in the remedy, but in the 
improper application of it. 

10. That in all states of the disease, where the in- 
flammation has gone farther than the membrane of the 
urethra, instead of wishing to remove the discharge, 
we should rather endeavour to solicit a greater flow 
of it; the running, in such circumstances, being only 
a secondary object, when compared with the conse- 
quences which are apt to ensue from inflammation 
proceeding to a great height. For the more certain 
prevention of which, blood-letting, both general and 
local, are particularly useful on the first approach of 
such symptoms as indicate an affection, either of the 

* Vide Numbers 18 and 19 in the Appendix. 



Sec. XI. RECAPITULATION. 103 

mucous glands of the urethra, the prostate gland, or 
bladder. 

11. That when, notwithstanding blood-letting, 
alow regimen, and other parts of an antiphlogistic 
course, tumours form in Cowper's glands, or in any 
other parts contiguous to the urethra, and when sup- 
puration occurs in them, the matter should be imme- 
diately discharged by an incision of a sufficient size, 
and the sore treated in the usual way. 

12. That in affections of the prostate gland, which 
do not give way to blood-letting, opium alone is to be 
depended on for relieving the irritation and distress 
which ensue from them ; the pain being often so severe 
that no other remedy proves in any degree useful. 
Thai opium, in these cases, proves always most effect- 
ual when applied directly to the parts affected, in the 
form of injection; and that extract of hyoscyamus may 
be used when it is found that the costiveness, which 
usually results from opium, proves hurtful. 

13. That when the bladder is affected, opium or 
hyoscyamus are in like manner to be used to relieve 
pain. That uva ursi is the most effectual remedy for 
obviating the discharge of viscid mucus, the usual 
consequence of inflammation of the bladder, and that 
the thickening of the. coats of the bladder, which in- 
flammation, from whatever cause it arises, is apt to 
induce, has in some cases been removed by a gentle 
course of mercury. 

14. And lastly, it appears, that the leading symp- 
toms of Gonorrhoea are so much alike in both sexes, 
that the general method of treatment is similar in 
both ; only that in women, from the situation and 
organization of the parts affected admitting of it, in- 
jections may at all periods of the disease be used with 
more freedom than in men ; an inflamed state of the 
bladder being, in women, almost the only circumstance 
that can take place in Gonorrhoea to render injections 
improper. 



104 QE THE CONSEQUENCES Ofr Cll. Ill* 

CHAP. III. 

Of the Consequences of Gonorrhoea Virulenia* 

SECT. I. 

General Remarks on the Consequences of Gonorrhoea 
Virulenta. 

ALTHOUGH the treatment pointed out in the 
preceding sections for the cure of Gonorrhoea will 
in general prove successful, yet every candid prac- 
titioner will adroit that it is not always so, and that 
instances occur of different symptoms proving ob- 
stinate, notwithstanding a careful and attentive ap- 
plication of every remedy with which we are ac- 
quainted. 

The causes of this failure I have already endea- 
voured to explain. In this part of the work 1 mean 
to speak of the consequences of Gonorrhoea, some of 
which are, in most instances, the effect of misman- 
agement, while others ensue after the greatest care 
and attention in the conduct of the cure. They are 
all, however, of a local nature, and not necessarily 
connected with any general disease of the constitution, 
The following is the order in which I mean to treat 
of them : 

Gleet ; seminal weakness and impotency strictures 
in the urethra ; abscesses and fislulae in perineo ; de- 
ranged sensations in the bladder and urethra ; swelling 
of t e testicle ; swelling of the epidy dim-is and sper- 
matic chord ; swellings of the lymphatic vessels of the 
penis; swelling of the glands in the groin ; excoria- 
tions of the glans and prepuce ; phymosis ; paraphy- 
mosis ; warts on the glans, prepuce, and labia puden- 
di. And, lastly, I shall add a few observations on what 
may be termed Gonorrhoea Simplex, in which a dis- 



SeC. I. GONORRHOEA VIRULENTA. 105 

charge occurs from the urethra, without any infec- 
tious matter being applied to it. 



SECT. II. 

Of Gleets. 

WHEN the discharge in Gonorrhoea continues ot> 
stinate, after the symptoms of inflammation are re- 
moved, the disease is then termed a gleet. 

From this definition we might be led to imagine 
that the import of the term Gleet would be clearly 
and generally understood, and that no risk could oc- 
cur of its being misapplied. This, however, is not the 
case ; for the symptoms which one practitioner consid- 
ers as Gieet, are by others said to be Gonorrhoea. 
Some assert that Gleet does not lake place till the dis- 
charge becomes colourless, and resembles mucus ; 
while others are of opinion that Gonorrhoea changes 
into Gleet before this change of colour is perceptible. 

All agree in this, that Gleet does not take place so 
long as the discharge is capable of communicating in- 
fection; but no precise marks have yet been discov- 
ered by which we can judge of this circumstance 
with certainty. When the discharge becomes trans- 
parent and viscid, like mucus, I believe that no in- 
fection will ever ensue from it; but I also suppose 
that it is often equally harmless long before this change 
has appeared in it. By the use of astringent injec- 
tions, demulcents, and cooling purgatives ; and, in some 
cases, by the lapse of time alone, the running in Go- 
norrhoea will lose its colour, acquire a mucous ap- 
pearance, and even abate in quantity, and yet it will 
again become yellow, and appear in larger quantities 
than at first. In such circumstances the discharge 
may be considered as altogether deprived of the pow- 
er of communicating infection , at least no instance of 
the contrary has ever occured to me, and I have rea- 

14 



106 OF GLEETS. Cb. III. 

son to think, that, in every instance it will be found 
to prove inoffensive where the inflammation by which 
it was at first induced has been once completely re- 
moved, whatever the method of cure may have been 
by which this was accomplished : while, on the con- 
trary, I am convinced, from a variety of facts which 
might here be enumerated, that so long as the pri- 
mary inflammation of Gonorrhoea continues, however 
long this may be, the matter produced by it is equally 
capable as at first of communicating infection. Ad- 
mitting, therefore, that the running should not be 
denominated Gleet, so long as it is in any degree infec- 
tious, it is evident that this term ought not to be 
applied to it, till it has become clear and transparent, 
or till the inflammation by which it was at first in- 
duced is removed, and of which we can only be certain 
by the ceasing of the pain which accompanied the 
inflammatory state of the disease. The discharge in 
Gonorrhoea frequently disappears altogether, and the 
patient considers himself, for the space of several 
da}s, nay, in some instances, for weeks, as completely 
cured ; when, either b}~ violent exertion on horse- 
back or on foot, by excess in drinking, or too earlv 
connection with women, the running will again take 
place, with every mark of a new infection. When 
the patient, however, is conscious of not having ex- 
posed himself to the risk of being infected, he may 
always consider this renovated discharge as of a harm- 
less nature, provided the inflammation and pain by 
which it was at first excited had previously disap- 
peared. Among other proofs of this, I might men- 
tion various instances of married men, who, from 
Gonorrhoea contracted in youth, have frequently, 
during life, from one, or other of the causes I have 
mentioned, experienced frequent returns of this dis- 
charge, who, in this situation, have had frequent con- 
nexion with their wives, without communicating 
the disease. In some of these, the discharge will be 
absent for several weeks, nay, for months together ; 
while in others it has not disappeared for more than 



SeC. II. OF GLEETS. 107 

two or three days at once, during the space of twenty 
years. 

In all of them, upon its first recurrence, it has ex- 
actly the appearance of a new infection ; but the 
event soon shews it to be materially different. If as- 
tringent injections are employed, they, for the most 
part, put an immediate stop to the running ; an 1, 
when left to itself, the matter becomes more quickly 
colourless than it ever does in a recent case of Go- 
norrhoea. 

In one instance, a gentleman applied to me in a state 
of the greatest distress, the day alter his marriage. 
He came upwards of twenty miles from the country, 
with every appearance of a recent clap ; which, he 
assured me, had broke out that very morning, although 
no appearance of an infection, under which he former- 
]y laboured, had been perceived for upwards of three 
months, nor had he, during that period, been exposed 
to the risk of getting a new one. This, in the state 
of temporary frenzy, under which 1 found him, led 
to the distressful idea of his having been infected dur- 
ing the preceding night, by his newly married wife. 
I assured him that this was impossible ; for that, inde- 
pendent of the surity which he derived from tne un- 
blemished character of his wife, no infection could 
have appeared with such violence in such a short space 
of time; and on hearing that he formerly laboured 
under Gleet, I also ventured to say, that the discharge 
would probably disappear almost as suddenly as its 
approach had been rapid. My prediction proved true, 
I immediately threw up a vitriolic injection, and caus- 
ed him to repeat it three or four times in the course of 
a few hours. By five or six o'clock in the. afternoon 
nothing but a slight oozing from the urethra was per- 
ceptible; I furnished him with more of the injection, 
and he went home perfectly satisfied in the evening. 

This happened several years ago, and the same ap- 
pearances have uniformly recurred since that period, 
upon every connection with his wife, but no infection 
has ever been communicated to her. For a considera- 



168 01 GLEETS. Cb. III. 

ble time he always bad recourse to the inject ion on the 
running taking place, but at last, being perfectly con- 
vinced of its being perfectly harmless, be allowed it to 
go on ; so that for these last three or four years, he has 
seldom been many days together free of it. 

But although patients, from being long accustomed 
to this discharge, come to find that it does not commu- 
nicate infection, still they can never look upon it with 
indifference; they all find it troublesome and distress- 
ful, and are therefore, at times, anxious to get free of 
it. When, at the same time we consider, that a long 
continued Gleet is apt to lay the foundation of some 
very obstinate and perplexing affections of the urethra, 
it will at once appear, that in every instance, this symp- 
tom merits our serious attention. 

Gleet seems evidenlly to arise from different causes, 
requiring different modes of treatment: it will there- 
fore be proper to consider them separately. 

1. The most frequent variety of Gleet succeeds to 
the first stage of Gonorrhoea, in which we do not sup- 
pose that the original inflammation proceeded farther 
than the urethra itself, or the small mucous glands im- 
mediately emptying into it. 

When the cure of this variety of Gonorrhoea is in- 
terrupted either by improper treatment, or by negli- 
gence on the part of the patient, and when the dis- 
charge is thereby allowed to go on for any unusual 
length of time, Gleet is thus frequently produced. 
Astringent injections will, for the most part indeed, 
put a stop to the running, but the slightest excess very 
commonly excites a return of it. 

This variety of the disease we conclude to proceed 
from relaxation and debility in the parts first affected, 
and that the obstinacy with which it often continues 
depends upon a farther degree of weakness, induced 
in these parts by the longer continuance of the run- 
ning ; by which it would appear to have a power, if 
not counteracted, of continuing or propagating itself. 

By some, this idea of Gleet proceeding in any in- 
stance from weakness, is ridiculed; and as the sugges- 



SeC. II. OF GLEETS. 109 

tion comes from very respectable authority I think it 
right to take notice of it.* 

Mr. Hunter observes, that by mechanical weakness 
is understood the not being able to perform some ac- 
tion, or sustain some force ; by animal weakness the 
same; but he cannot understand the expression when 
applied to an animal performing an uncommon, or an 
additional action, as seems from the quantity of mat- 
ter discharged, to happen in Gleet. 

This opinion appears to be founded upon the idea 
of an increased discharge being alw ays the consequence 
of an increased actions in vessels of the part from 
whence it proceeds ; and it originates from his not dis- 
criminating between general debility and local relaxa- 
tion, or loss of tone in a particular part. 

Although an increased discharge in the vessels of 
any part would seem to imply an increased action in 
these vessels, yet the reverse of this will, I believe, 
in most instances, be found to happen ; and that affec- 
tions of this nature proceed chiefly, if not entirely, 
from local debility. Loss of tone in the exhalents 
will necessarily produce a more copious discharge 
of their contents than will probably happen while 
their power of retention remains entire. Were these 
vessels unconnected with the rest of the system this 
would not take place ; but connected as they are with 
the arterial system, while the vis a tergo remains the 
same, any partial debility to which they may be lia- 
ble, must, perhaps universally, be attended with a 
preternatural effusion of their contents. 

There is much reason to suppose, from the phe- 
nomena which occur in inflammation, that an increased 
action takes place in the vessels of the part affected : 
but during the existence of this increase of tone, we 
commonly find that in Gonorrhoea, the discharge is 
not so considerable as it afterwards becomes when the 
symptoms of inflammation abate. Nay, it is univer- 
sally known that the running is apt to stop entirely 

* Tide Treatise on the Venerial Disease by John Hunter, p. 100. 



1 1© OF GLEETS. Cb. III. 

when the parts affected inflame to a greater degree 
than usual, and that nothing so readily solicits a re- 
turn of it as the removal of this inflammation, by the 
use of emollient injections. 

This is an argument of some importance in favour 
of our opinion, and it is farther confirmed by the na- 
ture of all the remedies which we employ in Gleet, 
which are either of an astringent, strengthening kind, 
or consist of stimulating injections, and other applica- 
tions of a similar nature, which seem to act by excit- 
ing an increased exertion in the vessels of the affected 
parts, by which they are enabled to resist the action 
of the arterial system from behind. 

I therefore consider it as clear and decided that this 
variety of Gleet proceeds from relaxation and debility 
of the exhalents of the urethra, and, perhaps, of the 
excretory ducts of the smaller mucous glands of that 
passage. 

This opinion of Gleet being connected with debili- 
ty, may indeed be carried too far, as happens, I be- 
lieve, daily in common practice. Where Gleet has 
run on for any length of time, many think that it has 
either at first proceeded in a great measure from gen- 
eral weakness of the constitution, or that it has tended 
to excite such a general degree of debility as will ef- 
fectually obstruct every attempt, towards a cure, till 
this state of the system be removed. 

Hence the patients are with much care and anxiety 
enjoined the use of bark, steel, and other t nics, with 
a view to remove the general debility ; while less at- 
tention is usually given to the real cause of the dis- 
ease, the local relaxation of the parts originally af- 
fected. 

That general weakness often takes place in Gleet, 
and that it may even be induced by a long continuance 
of the discharge, will not be denied ; but I have much 
reason to think, that in practice, this idea is often car- 
ried farther than it ought to be. This must necessarily 
be the case whenever it makes us lose sight, as I have 
observed above, of the real origin of the disease ; but 



SeC. II. OF GLEETS. HI 

there is also cause to imagine, that in giving additional 
vigour to the system at large, we tend to increase the 
discharge by the urethra, unless the tone of the parts 
which have been more particularly weakened be at 
the same time restored. The reason of this has been 
explained above, and I have often had evident proofs 
of the hurtful tendency of the practice ; by which, 
while the patient, from the effects of sea-bathing, a 
full diet, and the use of tonics, was daily getting more 
full in flesh than he was before, the disease has evi- 
dently been gaining ground, from no particular atten- 
tion being given to the state of the parts from whence 
the running proceeds. 

In a stale of universal debility, whether .induced by 
a long continuance of the discharge, or any other 
cause, the greatest attention ought certainly to be giv- 
en to it; but what I wish to inculcate is, that in com- 
mon practice we rather do harm by considering this 
general relaxation of the system as the first object of 
attention, when, in fact, it often either does not take 
place at all, or only in such a degree as to render it a 
matter of very trifling importance, when compared 
with the disease in the urethra. 

In a great proportion of cases of this variety of 
Gleet, our attention should be almost entirely direct- 
ed to this affection of the urethra ; and by experience 
we find that such remedies are chiefly to be depended 
on as act directly upon the seat of the disease. 

A variety of medicines have been employed for this 
purpose, but they may all be comprehended under the 
two general heads of astringents and stimulants; for 
all that have yet been found useful in Gleet seem ei- 
ther to act by their astringent properties or by their 
power of stimulating the parts to which they are ap- 
plied. 

When astringent injections have not been already 
employed, they ought, in the first place, to get a full 
trial ; for although they do not always prove success- 
ful, yet they frequently do so, and we seldom or nev- 



112 OF GLEETS. Ch. Ill, 

er find that any risk ensues from them, as sometimes 
does from stimulating injections. 

Any of the astringent solutions for which preserip- 
tions are given in the Appendix, may be employed, 
but the vitriolic solution, No. 18, is one of the safest, 
and very commonly proves the most effectual. In the 
use of all injections of the astringent kind it is necessa- 
ry to throw them frequently up, not less than six or 
eight times a day. This was particularly inculcated 
in the use of injections in Gonorrhoea, and it proves 
equally proper in this variety of Gleet. 

But where astringent injections have already been 
employed for the cure of the preceding Gonorrhoea, 
and where there is no doubt of a complete trial hav- 
ing been given them, in such circumstances, as there 
would be no cause to expect advantage from a farther 
use of them, they ought to be laid aside. 

In that state of the disease where a plentiful dis- 
charge takes place, with little or no pain, and where 
astringents have been employed with no advantage, 
stimulating applications become particularly proper. 

The stimulants we employ are of two kinds; acrid 
solutions and mixtures in the form of injections and 
bougies. Which ever of them are used must be of 
such a nature as to stimulate the parts gently to which 
they are applied, but not so strong as to excite inflam- 
mation in any considerable degree. They prove most 
successful where they give only a moderate degree ot 
pain and heat in the urethra; such as is felt in the 
commencement of the first stage of Gonorrhoea. In- 
stances, indeed, often occur of a newly contracted 
clap carrying off a Gleet that has been of long dura- 
tion ; and as this is always productive of some degree 
of inflammation, we conclude that the remedies em- 
ployed in Gleet must act in a similar manner, viz. by 
gently stimulating and exciting tlie parts \o inflame in 
such a degree as experience shews to prove useful. 
To excite violent pain would at all times be improper, 
as the inflammation which this would produce might 
go farther than we would incline it to do. Much harm, 



SeC. II. OF GLEETS. 113 

indeed, has been done by want of attention to this cir- 
cumstance. A swelled testicle is not an uncommon 
effect of it; and I have known the inflammation carri- 
ed to the prostate gland and bladder. 

This, however, may always be prevented; nor can 
it ever occur but from great inattention. Wherever 
injections are used, they should at first be so weak as 
to excite only a very slight degree of uneasiness. 

In the formula? annexed to this they are of such a 
strength as to act in this manner in a great proportion 
of people, although, in some instances, 1 have found 
them rather weaker than necessary. An addition of 
strength, however, is so easily given, that at first they 
ought never to be stronger. 

One of the best injections for ordinary use is a weak 
solution of corrosive sublimate in water.* That is, 
in the proportion of an eighth part of a grain of the 
mercury to an ounce of water, which is as strong as 
it ought ever to be used at first; although I have met 
with some, who, in a gradual manner, have been 
brought to bear half a grain to an ounce. I know that 
some have advised it of a still greater strength, even 
to the extent of a grain of mercury to the ounce of 
water; but although I am in the daily practice of using 
this remedy, I never found any person who could bear 
it of this strength. I therefore suspect that those who 
advised it, have never known it used. 

I have taken the more particular notice of this, 
from several instances having fallen within my own 
observation, of very pernicious consequences ensu- 
ing from the use of injections containing too great a 
proportion of mercury, while no inconveniency arises 
from them when not stronger than those I have point- 
ed out. 

In some cases, where a solution of corrosive sub- 
limate by itself has failed, I have known the addition 
of saccharum satui ni prove useful ?; and in same very 

* Vide Appendix, No, 24. § Appendix, No. 25 

15 



114 OF GLEETS. CIl. III. 

irritable patients, in whom even the smallest quanti- 
ty of the mercury excited too much pain, an addition 
of mucilage has enabled them to bear it. Of this a 
formula is given in the Appendixf. 

A solution of crude sal ammoniac provesj sometimes 
effectual in tins state of Gleet. The volatile alkali, 
such as spiritus corn, cervi, and spiritus salis ammoni- 
aci, properly diluted, make likewise useful injections 
for this purpose, as in formulae No. 28 and 29 ; and 
verdigrise, dissolved either in oil, or in spirit of sal- 
ammoniac, afford also a very effectual form of injec- 
tion for the same purpose : formulae of these last are gi- 
ven in Nos. 30 and 31. ; and in some instances tincture 
of cantharides, properly diluted, as in No. 32, has 
been found to answer. 

Besides the circumstance of ascertaining the pro- 
per strength of these injections, a good deal of address 
is required in the application of them. They must 
not be employed either so long or so frequently as is 
requiied for astringent injections ; with these no harm 
can occur, however frequently they may be applied ; 
but injections of a stimulating nature should not be 
continued longer than is just necessary for exciting 
some degree of pain and inflammation in the affected 
parts. 

This being accomplished, a few days should elapse 
before any other remedy is employed ; for it some- 
times happens that the running will stop after these 
stimulating injections are laid aside, although, during 
the use of them, it appeared to be increased. But 
when, after an interval of three or four days, this 
does not appear likely to happen, injections of an as- 
tringent kind should be immediately employed, as we 
have already advised in the first stage of Gonorrhoea. 

Even these will not always succeed; for it some- 
times happens that the running, although it may dis- 
appear for a few days, will }et return again and again, 
with equal violence as at first. 

In such circumstances, the stimulating injections 

f Vide Appendix, No. 26, * No, 27. 



SeC. II. OF GLEETS. 115 

must be again renewed, and the inflammation ought 
now to be excited in a degree somewhat greater than 
before; fori have commonly found that this may be 
done with more safety in the subsequent applications 
of this remedy ; and in the more advanced stages of 
Gleet the higher the degree of inflammation that can 
with safety be excited, the greater certainty there is 
of its proving effectual. 

When injections do not accomplish a cure, we en- 
deavour to effect our purpose by the use of bougies. 
By irritating the urethra, bougies answer the same pur- 
pose with stimulating injections; and, in some instan- 
ces, they have appeared to prove more effect ual, per- 
haps from the support which they afford to the parts 
which have been deprived of their tone. This, how- 
ever, does not happen with any kind of cerlainty, in- 
somuch that I always give the preference to injections 
in the first instance, as being less formidable in the ap- 
plication to all such patients as have not been accus- 
tomed to the use of bougies. 

Bougies composed of the most simple mate' ials com- 
monly answer all that we expect from mis kind o.f rem- 
edy ; but when these fail in exciting a sufficient degree 
of inflammation, they are easily rendered more active 
by dipping them in oil of turpentine, in a thin liniment 
of wax and oil with a small proportion of red precipi- 
tate, or in common basilicon reduced with oil of tur- 
pentine, to the consistence of a liniment. 

I have no reason to think that mercurials act in the 
cure of Gleet in any respect as specifics; but the stim- 
ulus which mercurial ointment gives to the urethra, 
when applied upon bougies, proves often as effectual 
as that from any medicine which we employ. It is 
proper, however, to observe, that the ointment for this 
purpose ought to be strongly impregnated with mer- 
cury : there should not be less than equal parts of 
quicksilver and hog's-lard ; and I have sometimes 
thought that mercury, extinguished by triturating 
with honey, acts more certainly as a stimulant than it 
usually does in the form of an ointment. 



116 OF GLEETS. Ci). III. 

If the constitution has been much debilitated, we 
ought, while the application of remedies to the dis- 
eased parts is going on, to advise a nourishing, invigo- 
rating diet. The patient should be allowed animal 
food, and a moderate portion of red wine daily ; and 
in such circumstances bark may with propriety be ex- 
hibited as a tonic : but for the reasons I have given 
above, I have much cause to think that the general 
practice of giving bark, steel, and other tonics, in eve- 
ry case of this kind, is by no means well founded, and 
in many instances that it does harm. 

Some of the stimulating astringent balsams, given 
internally, frequently prove useful here; probably 
from their tendency to stimulate in a more particular 
manner the organs of urine than any other part of the 
body. Balsamum 'copaiba is chiefly used for this 
purpose, but Canada balsam, and all the turpentines, 
may be employed with perhaps equal advantage. 
Fifteen or twenty drops of any of these may be given 
three or four times a day. 

A cautious use of cantharides has also proved ser- 
viceable in this variety of Gleet. Ten drops of the 
tincture may be given two or three times a day. 

But although some advantage mav be derived from 
all of these remedies, when employed along with local 
stimulants, as we have advised above, yet no depend- 
ance is to be placed upon them when they are not con- 
joined with these. This, it may be said, renders the 
advantages to be expected from them doubtful and 
equivocal ; but in different cases I think T have 
perceived greater advantages from a combindiion of 
these two sets of remedies, than usually occurs from 
a separate use of either of them. 

Cold bathing is a remedy commonly advised in 
Gleets, and where the constitution is so much debili- 
tated as to require attention, it will very generally an- 
swer a good purpose ; otherwise no advantage can pro- 
bably accrue from it, if it be not from the local appli- 
cation of cold to the parts chiefly affected, fn this 



SeC. II. OF GLEETS. 117 

view, the daily effusion of cold water upon the penis, 
and the bathing of the perineum, proves sometimes 
useful. 

2 The next most frequent variety of Gleet succeeds 
to the second stage of Gonorrhoea. After all the symp- 
toms excited by the actual presence of inflammation 
have subsided, this variety of the disease is very apt 
to terminate in Gleet. 

In the third section of the last chapter I endeavour- 
ed to shew, that in this stage of Gonorrhoea, Cowpers 
glands are chiefly affected, and that they afford a great 
proportion of all the matter that is discharged. Any 
inflammation which occurs along with this in the mem- 
brane of the urethra, is, for the most part, easily re- 
moved, so that the Gleet, which often succeeds, pro- 
ceeds either altogether, or nearly so, from the cavities 
of these glands. 

Gleet, proceeding from this cause, is, for the most 
part, easily distinguished from that which we have 
described as the first or most frequent variety of the 
disease. In this last, the matter usually proceeds from 
within an inch, or little more, of the glans, or when 
pa ris farther back are affected, the discharge is forced 
off from them by very gentle pressure upon the pe- 
rineum : but, in the other, the matter is, in every 
instance, found to proceed from the upper part of 
the urethra; a greater degree of pressure upon the 
perineum is necessary to force it out ; and some de- 
gree of fulness, accompanied with irritation, and 
even pain, is experienced on the perineum being pres- 
sed upbn for this purpose. 

We are also assisted in the diagnosis by the history 
of the preceding Gonorrhoea ; for it will be uniformly 
found that the first variety of Gleet has succeeded 
to the first stage of Gonorrhoea, and that the second 
stage of Gonorrhoea has given rise to that which we 
are now considering. 

In the treatment of Gleet it is of importance to have 
this difference ascertained, for the remedies which 
commonly accomplish a cure in the one, are used in 



118 OF GLEETS. Cll. III. 

the other either without any advantage whatever, or 
even with evident proofs of doing harm. Thus, al- 
though in the first variety of Gleet, we depend so 
much upon stimulating injections, that a cure in most 
instances cannot be accomplished without them ; in 
the other, where the larger glands of the urethra are 
affected, they very commonly render every symptom 
worse than it was before. They at least do so where 
ihe injection is of such a strength as to excite pain and 
inflammation ; and if weaker than this, it may be used 
for an indefinite length of time, without any effect re- 
sulting from it. The glands opening into the urethra 
being here the seat of the disease, astringent injections, 
applied as we have elsewhere observed, to their excre- 
tory ducts, may produce a temporary stoppage of the 
discharge ; but, as they do not reach the cavities of the 
glands, no permanent advantage can be expected from 
them. While, again, when an injection is used of such 
a strength as to excite inflammation upon the ends of 
these ducts, it is vei'3 7 apt to produce swellings in the 
glands themselves, which at last commonly terminate 
in suppuration, to the great distress and disappoint- 
ment both of the patient and practitioner. 

Whenever it is therefore discovered with certain- 
ty, that this variety of Gleet exists, injections should 
be no longer employed ; or when, for the satisfaction 
of the patient, a farther trial of this remedy becomes 
necessary, such preparations only should be used as 
are moderately astringent. 

In such circumstances bougies, and blisters to the 
perineum, are the most effectual remedies I have ever 
employed. The bougies should be of the mildest 
kind, such as stimulate the parts gently, without ex- 
citing inflammation. By this, and by the support 
which their size and form afford to the weakened parts, 
they often prove highly serviceable ; and even when 
they do prove more powerfully stimulating than we 
may have wished or expected, they do not so readily 
do harm as injections; for the inflammation with which 



SeC. II. OF GLEETS. 119 

this may be attended is always accompanied with an 
instantaneous discharge of matter, by which the incon- 
venience that otherwise might result from them is very 
effectually prevented. 

Bougies ought, for every purpose, to be as large as 
the capacity of the urethra will admit; but their be- 
ing of a full size is more particularly necessary in this 
variety of Gleet than for any other malady; for it is 
chiefly by their size that they prove useful here. 

In most instances of this kind it appears, in the 
course of a few days, whether bougies are to be of 
service or not; but no permanent advantage is ever 
to be expected from them if they are not continued 
for a considerable time. When the disease has been 
of long duration, the bougies ought to be applied for 
the space of ten or twelve weeks, and not even desist- 
ed from then if the cure be not completed. Tt is 
proper, however, to observe, that after bougies have 
been used for such a length of time as ought to accom- 
plish a cure, they should from time to time be laid 
aside, that the effects produced by them may be discov- 
ered; for while they are daily introduced we can nev- 
er know with certainty whether any discharge which 
takes place is the effect of the disease, or of the irri- 
tation which they excite; as bougies can never be ap- 
plied for any length of time together, not even to a 
sound urethra, without being found covered with mat- 
ter, or with mucus in the form of matter, on their be- 
ing withdrawn. 

When bougies fail, a blister applied over the whole 
perineum sometimes proves serviceable. Whether it 
is by the stimulus which they give to the parts affect- 
ed, or by the discharge which they excite, is uncer- 
tain : for in some an evident advantage ensues upon 
the first or second day from their application, and be- 
fore any quantity of discharge can have occurred, 
while in others no effect is observed to result from them 
till the second, third, or perhaps, fourth blister ha^ 
been applied. In a few instances, some advantage 



120 OF GLEETS. Ch. III. 

has appeared to be derived from a small portion of the 
blistered part being kept open with epispastic oint- 
ment, which, in two cases of much obstinacy, led me 
to advise the introduction of a small seton on one 
side of the perineum ; but although this seemed like- 
wise to lessen the discharge, the advantage derived 
from it was neither so great nor so obvious as to com- 
pensate the very disagreeable nature of the remedy. 

In very obstinate cases of this variety of Gleet, the 
patient will frequently be found to be of a scrophulous 
constitution. If the disease has not already appeared 
in a more evident manner in other parts of the body, 
it will at least often happen that the glands of the neck, 
and other suspicious parts, will appear to be tumefied, 
and that the complexion of the patient, which is com- 
monly delicate, gives much cause to conclude that the 
system is not free of it. 

In such circumstances, all the remedies usually em- 
ployed in serophula will from time to time, be advis- 
ed. Bark and hemlock have sometimes proved useful 
here ; but no remedy that has yet been employed in 
serophula is in any degree equal to sea-bathing. 

In enumerating the different varieties of Gleet, I 
have proceeded in the order in which they most fre- 
quently appear. The next of which I shall take no- 
tice proceeds from strictures in the urethra. 

In an ensuing section I shall find it necessary to en- 
ter more minutely upon the consideration of venereal 
strictures in the urethra: at present, therefore, it 
seems only requisite to sa} 7 , that they are to be con- 
sidered as a very frequent cause of Gleet. The spon- 
gy surface of the substance from which these strictures 
are produced is very apt to become tender and excori- 
ated. A slight degree of ulceration thus takes place 
which continues to give out matter while any degree 
of the stricture remains, and where the extent of the 
disease is considerable, this of itself would afford a 
very copious discharge; but besides this, the remora 
which every stricture produces, of urine and rrtueus 



Sec. II. OF GLEETS. 121 

between the part on which it is seated and the bladder, 
acts as a very powerful cause of irritation, and in this 
manner renders the discharge more abundant than we 
almost ever find it to be in Gleet, proceeding from any 
other cause. 

Where strictures are not suspected as the cause of 
the discharge, as often happens where the obstruction 
to the flow of urine is not remarkably great, the pa- 
tient as well as the surgeon is apt to be deceived, and 
to proceed daily with the plan of effecting a cure by 
injections, balsam of copaiba, and other astringents. 
None of these remedies, however, have any influence, 
and the discharge, after many years continuance, is 
found to be nearly in the same slate, either as bad, or 
perhaps worse, than at first. Of this every practition- 
er must have met with instances, and they always 
prove the source of much perplexity and embarrass- 
ment. 

In every case, therefore, where Gleet resists the 
usual remedies, and is thus particularly obstinate, it 
ought to be our first object to ascertain the real state 
of the urethra, and to learn whether strictures are 
present in it or not. In some cases this will at once 
be known from the state of the symptoms obtained 
from the patient, as well as from external examination 
of the urethra from the point of the penis, to the 
fundament. This, however, will only happen in the 
more severe degrees of the disease. Where the ob- 
struction is slight, it may, as we have already ob- 
served, pass unnoticed ; so that in all such circum- 
stances, and where there is any cause for doubt, the 
passage should be examined with a bougie, by which 
alone any certainly upon this point can be obtained. 

When the existence of stricture is discovered, all 
other remedies ought at once to be laid aside, and the 
cure trusted entirely to bougies. Hereafter we shall 
have occasion to speak more particularly of bougies; 
at present we need only say, that they are the only 
remedy upon which we can depend for the removal of 

10 



122 OF GLEETS. Ch. III. 

strictures, and that they very commonly prove effectu- 
al when duly persisted in. 

When the discharge proceeds entirely from stric- 
tures, it will, for the most part, soon subside on these 
being removed ; but when it continues more than a 
few days after the bougies are withdrawn, it will be 
proper to employ astringent injections in order to car- 
ry it off. Lime-water answers well ; for this particu- 
lar purpose, indeed, it answers better than any other 
form of injection I have tried, but it requires to be 
diluted with an equal quantity of common water. 

4. The last variety of Gleet of which we have to 
take notice proceeds from a swelled state of the pros- 
tate gland, and succeeds, as we have already had oc- 
casion to see, to the third stage of Gonorrhoea Viru- 
lenta. 

In treating of Gonorrhoea the symptoms were enu- 
merated by which affections of the prostate gland may 
be discovered ; but we have no certain means of know- 
ing to what extent it may be swelled but by examin- 
ation with the finger in ano. 

Besides the inconveniency which occurs here from 
the discharge itself, and which is common to this with 
every variety of Gleet, there is always a good deal 
of uneasiness, and even pain, produced by the swel- 
ling of this gland, which excites a more frequent de- 
sire to pass water than any other variety of the dis- 
ease, together with a sensation of heat and fulness 
over the whole parts contiguous to the anus. The 
tenesmus which often takes place is also a very trou- 
blesome symptom. 

Gleet, proceeding from this cause, is sometimes 
combined with other varieties of the disease, particu- 
larly with that which was last described. In this case 
the discharge has most frequently the appearance of 
being a mixture of pus and mucus; but when the run- 
ning proceeds entirely from an affection of the pros- 
tate gland, it is thinner than purulent matter, and, al- 
though sometimes tinged of a white or yellow colour, 
it is more frequently of the consistence and colour of 



SeC. II. OF GLEETS. 123 

mucus. This makes it often be mistaken for a dis- 
charge of semen. 

No injections are of any utility in this variety of 
Gleet ; nor is any advantage derived from bougies. 
On the contrary, they are both apt to do harm, par- 
ticularly a perseverance in the use of them; a prac- 
tice which those not accustomed to this branch of bu- 
siness are very apt to fall into. Swellings of this gland 
are very commonly attended with some degree of ob- 
struction to the passage of urine, and when this is 
mistaken for strictures, as often happens, bougies are 
immediately advised in order to remove it. 

Bougies, however, never prove useful here : on the 
contrary, they very commonly irritate the gland to 
such a degree, as to excite both an increase of the 
pain and of the discharge. 

Opiates are the remedies upon which, we place most 
dependence. By allaying irritation, they not only- 
keep the patient free from pain, but in doing so they 
tend more than any other remedy to lessen the dis- 
charge. It must, however, be acknowledged, that 
they act chiefly as palliatives; but the mere preven- 
tion of pain is a point of no small importance in a dis- 
ease which otherwise is apt to render the patient mis- 
erable. In speaking of affections of this gland in the 
third stage of Gonorrhoea, I advised opiates to be 
used in clysters, instead of being taken by the mouth. 
They d<» not, in this form, so readily induce sickness, 
and they usually prove more effectual in relieving 
pain. 

In several instances, where no great advantage 
was derived from all the quantity of laudanum that 
durst be given by the mouth, patients have been kept 
ea v by a grain or two of opium dissolved in a small 
quantity of mucilage, and thrown from time to time, 
into the rectum. 

Where this disease occurs in scrophulous constitu- 
tions, an occurrence by no means uncommon, hyoscy- 
amus, cicuta, and sea-bathing, are the remedies usual- 
ly employed: and although they do not often accom- 



124 OF GLEETS. Ch. III. 

plish a cure where the gland is much swelled, yet they 
frequently afford relief; and slighter degrees of the 
disease have, in some instances been removed by them 
entirely. 

Some practitioners, as I have already had occasion 
to remark, give mercury in every variety of Gleet, 
but I have never known any advantage derived from 
it, and where the prostate gland is affected it very com- 
monly does harm. 

As I have mentioned above, that in Gleet proceed- 
ing from strictures in the urethra, some slight degree 
of ulceration takes place, it may be imagined that 
mercury ought in such instances to prove useful, from 
its well known powers of healing venereal ulcers. It 
is not, however, found to promote the cure of these 
ulcerations; a circumstance that may be consider- 
ed as a farther proof of the difference between Gonor- 
rhoea Virulenta and Lues Venerea ; for if affections of 
this kind were induced by the matter of Lues Vene- 
rea, mercury would seldom fail in curing them, while 
no other remedy would ever prove successful. But, 
instead of tiiis, I have repeatedly found, that no ad- 
vantage is derived from mercury in the treatment of 
this symptom, while bougies, when properly managed 
very commonly prove effectual. 

What we have hitherto said upon the subject of 
Gleets relates chiefly to the disease as it occurs in 
men, it being in them both more frequent, and of 
much more difficult treatment than it usually is in wo- 
men. 

We often meet with it, however, in women ; but 
it is proper to remark, that it is equally difficult to 
distinguish it from fluor albus, as in a former section 
we have observed Gonorrhoea to be. Referring- to 
"what was then said upon the means of distinguishing 
between the two diseases, we shall at present proceed 
shortly to observe, that in women we depend entirely 
for the cure of Gleet upon a proper perseverance in 
the use of injections. When after a due continuance 



Sec. II. OF GLEETS. 125 

of such as we reckon astringent,* if the discharge still 
continues, those of a stimulating nature should be em- 
ployed, particularly Nos. 24 and 25. 

When the disease is seated in the vagina, as is gen- 
erally the case, these injections may be thrown up 
with freedom; but, when the discharge proceeds from 
the urethra they ought, on account of the contiguity 
of the bladder, as we had occasion to remark in a for- 
mer section, to be thrown up with much caution. 

In women I have sometimes found that a Gleet has 
proceeded from ulceration within the verge of the va- 
gina. In such instances injections have little or no in- 
fluence; and as sores of this kind -are commonly con- 
nected with Lues Venerea, they can only be cured by 
a course of mercury. 

It is proper, however, to remark, that women are 
liable, as men are, to excoriations from the acrimoni- 
ous nature of the matter of Gonorrhoea. A discharge 
of matter from this cause will be most readily cured 
by astringent injections, or bathing the parts with lime- 
water, or a saturnine solution. 

I have never known the real venereal stricture oc- 
cur in women. Excrescences form in the urethra from 
other causes; but stricture from Gonorrhoea must ne- 
cessarily, in this sex, be a rare occurrence. If it is 
ever met with, bougies must here, as in men, be de- 
pended upon for a cure. 

* Vide Appendix, Xos. 18, 19, and 20. 



We find the acetite of lead in solution is a favourite prescription 
of our author, as well as of many others, especially young practi- 
tioners. We have sometimes used it but not lately, having as we 
are convinced, observed Gleet to be a frequent consequence : — 
From our own observations we cannot help thinking that in this 
complaint, the lead acts as a sedative, and that in some cases an almost 
incurable degree of local debility is induced. 

On this subject we are happy to have it in our power to quote a 
very accurate observer, Dr. Hosack of New-York; He observes, 
" In Gonorrhoea lead water is the usual prescription, especially of 
young practitioners. The writer of this article, many years since 



126 OF IMPOTENCY FROM Ch. III. 

became acquainted with the pernicious consequences of that injec- 
tion. Indeed, in every case of Gleet following Gonorrhoea, for 
which lie has been consulted within twenty years past, he has, with- 
out a single exception, traced it to the debilitating sedative effect of 
that metal. Most cases too of the inflamed testis, which he has 
seen attendant upon Gonorrhoea, have been produced by the same 
cause, viz. the too early and sudden check of the secretions of the 
urethra by the use of lead injections." 

Vid. Med. and Philosoph : Register, vol. iv. page 159. 

Mr. J. Robertson, surgeon in Edinburgh some years since pub- 
lished a book on the use of the tincture of cantharidcs in the cure 
of Gieet and Leucorrhoea. This remedy unquestionably acts from 
its stimulant properties, and we know that it has frequently proved 
successful. It must be employed with caution, commencing sel- 
dom with more than fifteen drops, as from the great irritability of 
the parts a distressful decree of inflammation might be the conse- 
quence : this quantity may however be gradually increased, often to 
thirty drops, two or three times a day. 

We have frequently succeeded in performing a perfect cure, with 
the linament, page 69, Ed. 



SECT. III. 

Of Impokncy from Seminal Weakness. 

WE here mean by mrpotency a deprivation of the 
power of propagating the species. 

This may proceed from various causes: but it is 
that variety of it only which is usually supposed to 
arise from weakness in the seminal vessels that we are 
now to consider. 

It is an occurrence which, in young people, either 
in idea or reality, takes place daily; and as it proves 
at all times a source of much anxiety and distress, it 
necessarily becomes a frequent object of attention to 
practitioners. A degree of debility inducing want of 
retention in the seminal vessels is, no doubt, occasion- 
ally met with; but the strong desire which Nature has 
wisely implanted in all men to be complete and entire, 
in whatever relates to the propagation of his species, 
is often in early youth, the cause of much ill-founded 



fteC. HI. SEMINAL WEAKNESS, 127 

suspicion on Ibis point, and of circumstances respect- 
ing it being considered as real which never took place. 

Thus there is .nothing more common than vouns: 
people supposing they are weak and debilitated, on 
perceiving an oozing of mucus from «he urethra, or a 
discharge of semen when at stool. The first, howev- 
er, is natural to many when in full health, and where 
no suspicion of weakness exists; and the latter, or a 
discharge of semen, must at all times be the conse- 
quence of hardened iceces compressing the vesiculse 
seminales, when these vessels are full of semen. But 
suspicion on Ihis point being once awake, it is often 
difficult, and sometimes impossible, to remove it ; in- 
somuch that many have been rendered miserable by 
this alone, where no vestige of disease existed. 

It is considered as one of the most certain proofs of 
weakness in the seminal vessels when a discharge of 
semen instantly succeeds to an erection, or, perhaps, 
to an imperfect degree of it. But this may also happen 
from a state of over-excitement in the other parts of 
generation, and I also believe that it often occurs from 
the seminal fluid being collected in too great quantity 
in the vesiculse seminales. I have reason indeed to im- 
agine, as will appear in the sequel, that this is the most 
frequent cause of all such affections* 

It may be said, if the disease exists, and the patient 
is rendered completely impotent-- that the cause of his 
being so is a point of little importance. It will appear, 
however, that this is by no mea [he case; for while 
real impotency is in a great proportion of cases to be 
considered as incurable, we have it in our power, per- 
haps, in most instances of approach to this slate to ac- 
complish a cure. 

In the last section we have seen that Gleet proceeds 
at one time from an affect ion of the glands in other 
parts of the urethra, but in some cases that it arises 
from a swelling of the prostate gland. When this ex- 
ists for any length of time, we find that not only the 
duct of the prostate gland becomes weak and relaxed, 
but that a loss of tone takes place in some of the con 



128 OF IMPOTENCY FROM Cb. III. 

tiffuous parts, particularly in the excretory ducts of 
the vesiculse seminales; insomuch that a great propor- 
tion of all who have long laboured under Gleet from 
affections of this gland, have likewise been liable, in 
some degree, to seminal weakness. It is well known 
that long continued Gleets, are often the cause of 
Impotency. For the most part, it is supposed, that 
this happens from the general debility which they 
induce. In some instances this may be the case ; but 
J have much reason to think that they act much more 
frequently by inducing a local weakness only iri the 
parts destined for the reception of the semen. This I 
conclude to be the case from this kind of debility tak- 
ing place where there is no appearance whatever of 
general weakness, for instances often occur in consti- 
tutions apparently firm and healthy, of such degrees 
of weakness in the seminal organs, that emissions take 
place, not merely from partial erections and lascivious 
ideas, but from the ordinary friction applied to the pe- 
nis in riding and walking, and, in some instances, from 
the effect of heat alone, whether excited by wine, ex- 
ercise, or sitting near a fire. 

In people who have suffered much from frequent 
returns of Gonorrhoea, particularly where Gleet has 
taken place from the cause I have mentioned, I have 
known several instances of the semen running off by 
the slightest application of any of the causes just enu- 
merated. 

The local weakness thus induced in these parts by 
Gleet seems very much to resemble the effects of 
Onanism ; a habit so baneful to many of our youth, 
that I believe it to be more destructive in its conse- 
quences than a great proportion of all the diseases to 
which in early life ihey are liable. Were it to prove 
hurtful to those only whose self indulgence gives rise 
to it, there would be less cause to regret the effects of 
it; but, besides rendering the parent himself misera- 
ble, it evidently entails the highest distress upon pos- 
terity, by generating languor, debility and disease 
instead of that strength of constitution, without wliicjj 
there can be no enjovment. 



SeC. III. SEMINAL WEAKNESS. 129 

Some, I know* have entertained a different opinion 
upon this point, and imagine that no bad effects are to 
be dreaded from the habit of which we are now speak- 
ing*. But this is so directly contrary to the expe- 
rience of others, and I have had so many instances in 
the course of my own practice of constitutions being 
irretrievably ruined by indulgence in it, that I cannot 
avoid, in the strongest manner, giving my opinion of 
it : nor does it appear that any benefit could result to 
society from a contrary opinion being admitted, even 
allowing it to be well founded ; for although no imme- 
diate harm might ensue from it to the constitution, it 
ought to be discouraged as unnatural, and from its 
tending to divert the attention from an enjoyment of 
a much superior kind. While, therefore, there is 
much cause to consider the practice as highly dange- 
rous to all who follow it, and while such a propensity 
prevails towards it in that early age when boys cannot 
form a judgment of its deleterious tendency, I consid- 
er it as incumbent on those who write upon it to paint 
it and the baneful effects which result from it in their 
true and proper colours. 

In the treatment of this variety of Impotency, wheth- 
er it has been induced by Onanism, or whether it be 
the consequence of Gleet, it is proper to distinguish it 
into two stages. 7'he one, so far as I have seen, be- 
ing of a nature that does not admit of any certain rem- 
edy, while the other may, in most instances, be com- 
pletely cured. Many consider it so certainly as incu- 
rable that the patient is led to despair from the first 
approach of it, and the opinion is often unfortunately 
realized merely from the cause I have mentioned, our 
not distinguishing the two stages of the disease, and 
allowing that which I suppose may be easily removed, 
to proceed without any attempt for this purpose, to 
that state of it, which, in most instances, may be con- 
sidered as incurable. 

Practitioners are frequently applied to by young 

* Vide Treatise on the Venereal Disease, by John Hunter chap, xii, 

17 



130 OF IMPOTENCY FROM CI). III. 

men labouring under what I shall term the first stage 
of Gleet ; who, finding that a seminal discharge takes 
place from the slightest causes, perhaps merely from 
their being in company with women ; from lascivi- 
ous dreams; or from the parts of generation being in 
any degree overheated, begin to be afraid that they 
shall never again have the power of retention, and 
conclude therefore that they cannot with propriety 
enter into a matrimonial connection. We often find 
that they admit Onanism to have been the primary 
cause of their distress, although, for a great length 
of time, perhaps for a number of years, they assert, 
and with no reason on our part to doubt them, that 
they have been entirely out of the practice of it. 

In this situation, whatever may be the appearance 
and habit of body of the patient, strengthening astrin- 
gent remedies are prescribed, such as bark, steel, bal- 
sam of copaiba, cold bathing, &c. ; and whatever are 
bis views, he is advised to avoid matrimony and all 
venereal intercourses. 

In a great proportion of cases, however, I am con- 
vinced that this practice and this advice are errone- 
ous. Following the bulk of practitioners, I easily 
adopted them ; but no good resulting from them I 
have long since relinquished them, and I have seldom 
failed of success by advising measures of an opposite 
nature. 

In a great proportion of all that are injured by 
this destructive habit, a morbid irritability of the or- 
gans of generation seems to be excited. By this a 
greater quantity of the seminal fluid is secreted than 
the vesicular seminales can retain : in consequence of 
which, it either bursts out during nocturnal dreams, 
or is easily excited to flow by the application of any 
of the causes above-mentioned. 

Even after the habit has been long left ofT I have 
known the effects of it continue in a very distressful 
degree, and I conclude that they proceed chiefly 
from too plentiful a secretion of semen, from the na- 
ture of the remedy which in most instances has prov- 
ed successful. 



SeC. III. SEMINAL WEAKNESS. 131 

Instead of advising abstinence from women, I al- 
ways inculcate as frequent connection as natural de- 
sires seem to require ; and when matrimony is in 
view, instead of being afraid of it, as often happens 
with this class of patients, from a fear of their not 
performing the functions of it properly, I uniformly 
bold it forth as the most certain remedy. 

The idea of inability is so strongly prevalent with 
many, that they are with difficulty prevailed upon to 
make the attempt; but the effects of it are so cer- 
tain, that with patients in such circumstances as we 
are now considering, it may always be advised with 
the greatest confidence of success. Nor is the assist- 
ance of other remedies required in this plan of cure ; 
at least in various instances, patients, who, for ma- 
ny years together had been almost constantly taking 
such remedies as they judged to be of an invigorating 
nature, without any advantage resulting from them, 
and who therefore were induced to consider their 
complaints as incurable, have, on laying ail of these 
aside, become completely and entirely well in the 
space of a few weeks after marriage. The irritabil- 
ity of the organs was thus diminished ; the morbid 
increase of the secretion was removed ; and the se- 
minal receptacles, not being over distended, were 
soon found to be endowed with a sufficient degree of 
retention. 

This being a very frequent variety of the disease, 
I can speak of it, and of the remedies employed in it, 
with some degree of certainty ; and I can with con- 
fidence say, that none of those commonly advised 
have ever, in the course of my observation, had any 
obvious influence ; while the plan I have pointed 
out, very generally surpasses in its effects all that the 
patient could hope from it. 

When a swelled state of the prostate gland is con- 
nected, as I have sometimes found, with this variety 
of the disease, it. necessarily renders the event m >re 
doubtful, and the effect, even of this and every 
other remedy, more uncertain. But even here the 



132 OF IMPOTENCY FROM Ch. III. 

course I have advised will sometimes prove success- 
ful. It will uot remove any affection of the gland, 
but where the disease of that organ is not in a great 
degree, it proves equally effectual in removing the 
other, as if the gland was entirely sound ; and this 
obviates one ot the greatest sources of misery to the 
patient. 

It may be said, that while this or any other varie- 
ty of Gleet exists, the remedy I have pointed out 
cannot with any propriety be advised, from the risk 
of communicating infection. We know, however, 
that real Gleet does not communicate infection to 
others ; and the means of distinguishing it from 
Gonorrhoea are by no means equivocal. Many in- 
stances have fallen within my own observation, and 
others must often meet with it, of this being clearly 
the case. I know, at this time, several instances of 
men who have been married for many years, who, 
during the whole period, have laboured under dif- 
ferent varieties of Gleet, and who have never com- 
municated the disease either to their wives or chil- 
dren. Gleet in men seems to be equally incapa- 
ble with flu or albus in women to communicate infec- 
tion. 

In that stage of the disease which we have just been 
considering, a cure, we observe, may, perhaps, in 
every instance, be accomplished. But when it has 
been of such duration as to form what may more pro- 
perly be termed seminal weakness, and what I shall 
term the second stage of the disease, a very different 
prospect presents itself. The patient may even, in 
very advanced periods of the disease, derive advan- 
tage from a well-regulated diet and other circum- 
stances, by which his situation will be rendered much 
more comfortable than it otherwise would be ; but in 
this situation a complete removal of the disease is 
scarcely to be expected: at least little dependence is 
to be placed upon the remedies usually employed for 
that purpose. 

Tliis very distressful stage of seminal weakness is 



SeC. III. SEMINAL WEAKNESS. 133 

often the consequence of Onanism long persisted in ; 
and it is, as we have remarked, the frequent conse- 
quence of Gonorrhoea and Gleet. In all such cases 
the disease seems to proceed from real weakness, or 
debility in the excretory ducts of the vesiculae semi- 
nales ; for it commonly happens where the whole sys- 
tem is much relaxed and emaciated ; where there is 
therefore no cause to imagine that it can arise from 
too plentiful a formation of semen ; and of which, in- 
deed, we often meet with a very decisive proof, from 
a constant mucous-kind of oozing being perceived in 
the urethra, while no ordinary cause of excitement 
is capable of producing any regular discharge or emis- 
sion of semen. 

In this situation a variety of remedies are employ- 
ed, chiefly with a view to restore and invigorate the 
tone of the weakened parts ; such as bark, steel, hal- 
samum copaiba, and cold bathing. At other times, 
where the disease is supposed to proceed from a defi- 
ciency of semen, provocatives are prescribed; such 
as high seasoned foods, all the terebinthenate balsams, 
and cantharides. But although I have had many op- 
portunities of observing a complete trial of these, I 
never knew any advantage derived from them. The 
only course, which in such circumstances I ever knew 
prove useful, was such as merely tended to restore 
the patient to his usual state of health. If Onanism 
has induced the disease, nothing will afford even the 
chance of a recovery till this is left off. Whatever 
may have been the cause of it, he ought to be put 
upon a nourishing diet ; and he should live in an ele- 
vated, dry situation. Sea-bathing should be advised; 
and costiveness, with every thing that might tend to 
irritate the parts chiefly affected, should be avoided. 

With a view to lessen that degree of irritability with 
which this disease is usually connected, opiates have 
been advised ; but although I have often given them a 
full trial, I never knew any real advantage obtained 
from them. On the contrary, they have often appear- 
ed to do harm ; for although they procure rest, yet 



134 OF IMPOTENCY FROM Ch. III. 

the sleep which they give is always disturbed ; the pa- 
tient awakes in a state of more anxiety and distress 
than he experienced on going to bed ; and when opi- 
ates are habitually used, costiveness can scarcely be 
prevented by means of remedies, which, in this situa- 
tion, ought not to be given. 

Hemlock is often used here; but I have never 
known any obvious advantage derived from it. Hyos- 
cyamus, by acting as an anodyne, while it does not 
produce costiveness, has, in different instances, ap- 
peared to prove serviceable. One grain of the ex- 
tract may be given at first, and the dose increased in a 
gradual manner to three, five, six, eight, and even ten 
grains. 

Conceiving, from some circumstances connected 
with the disease, as well as from many of the symp- 
toms which ensue from it, that it may in some instan- 
ces be of the same nature with paralysis, I have, in 
several cases, advised electricity, and in one or two of 
these it appeared to prove serviceable, but never so 
decidedly, as to enable me to speak of it with confi- 
dence. 



SECT. IV. 

Of Obstructions in the Urethra from Gonorrhoea Vir- 

ulcnta. 

WHEN speaking of Gleet we had occasion to ob- 
serve that it is often the consequence of Obstructions 
in the Urethra. But Gleet, although the cause of some 
inconvenience and distress, is by no means the symp- 
tom of most importance with which Obstructions are 
accompanied. Strictures may take place in a certain 
extent, without giving much uneasiness, but whenever 
they arrive at such a height as to impede the flow of 
urine,they prove always the cause of distressand misery 
to the patient, and of much embarrassment to the prac- 
titioner. 



Sec. IV. SEMINAL WEAKNESS. 135 

Obstructions proceeding from Gonorrhoea Virulen- 
ta may be reduced to four general heads ; tumours in 
the substance of the urethra and contiguous parts ; 
spasmodic affections of the urethra ; caruncles, or 
fleshy excrescences, in the urethra ; and strictures, 
properly so called. 

i i. 

Of Turnouts in the Substance of the Urethra and con- 
tiguous Paris. 

WE have already had occasion to speak of Tu- 
mours, or swellings of the prostate gland, of swellings 
of Cowper's glands, and of the other smaller glands 
of the urethra. All of these produce obstruction to 
the flow of urine whenever they become of such a size 
as to diminish, in any degree, the magnitude of that 
canal. 

Referring to what has already been said upon this 
part of our subject, I have at present to observe, that 
in the commencement of all Tumours in these parts 
we ought, by every method in our power, to endea- 
vour to remove them by discussion, for which purpose 
local and general blood-letting are the remedies chief- 
ly to be depended on; and as these, when carried a 
sufficient length, and when assisted by a cooling regi- 
men, and the external use of cold saturnine applica- 
tions, seldom fail in removing them, they should al- 
ways be persisted in as long as there is the least chance 
of their proving serviceable. For although tumours. 
in this situation are often easily removed after suppu- 
ration has taken place, by the matter being freely dis- 
charged, and the sore treated in the usual way, yet, 
before arriving at this size, a good deal of distress al- 
ways occurs from them, and, in some instances, the 
sores heal with difficulty, while in others the matter 
bursts into the urethra, where it continues often dur- 
ing the life of the patient to excite a great deal of dis- 
tress.- 



136 OF TUMOURS IN THE Ch. III. 

In others again it bursts into the scrotum, and from 
thence into the surrounding cellular substance, and 
openings forming in consequence of this, commonly 
between the scrotum and anus, a very troublesome dis- 
ease is thus produced, termed fistula in perineo.* 

It is therefore obvious that it is much for the advan- 
tage of the patient that all tumours of this kind should 
be removed by discussion ; but when our endeavours 
for this purpose do not succeed, and when suppuration 
takes place, we have it often in our power to prevent 
many of the bad consequences which otherwise are 
apt to ensue. By opening such tumours immediately 
on matter being perceived in them, we prevent the 
risk of their bursting into the scrotum and urethra, so 
that in this situation we ought never to wait till they 
are so fully matured as otherwise might be proper : 
and when once they have come so far as to render it pro- 
per to discharge the matter, it ought to be done, as we 
have formerly observed, oy making an opening the 
whole length of the tumour. This prevents the matter 
from lodging, and from insinuating into the contigu- 
ous parts, while the sores which ensue heal more kind- 
ly than they usually do when smaller openings have 
been made. 

Among other consequences which sometimes occur 
from matter bursting from abscesses in this situation 
into the contiguous parts, it is proper to mention that 
the most distressful effects occur from its finding access 
to the corpus cavernosum of the penis. It usually 
spreads suddenly over the whole substance of the pe- 
nis; small openingstakes place in different parts of the 
swelling, at which the matter is discharged ; and these 
are always very difficult to heal : or, if the matter 
does not find a vent in this manner, it either bursts into 
the urethra, or the surrounding parts are apt to mor- 
tify. 

When mortification occurs in this situation, it either 
soon proves fatal, or terminates in the entire loss of the 

* For the treatment of this, vide system. of surgery, chapter xy. 



SeC. IV. CRETHRA. 137 

penis ; for a stop is seldom put to the disease till all the 
parts surrounding the urethra are destroyed, when am- 
putation of the remainder becomes unavoidable. Indeed 
the hsemorrhagy which is apt to occur from deep seated 
mortification of the penis is commonly of itself a suffi- 
cient motive for amputation being advised, for we can 
seldom put an effectual stop to the discharge till the 
mortified parts are all removed. 

For preventing mortification in this situation from 
spreading, opium has been recommended. I have cer- 
tainly observed it prove useful in gangrene, both in 
these parts and in others ; "but more dependence is for 
the most part to be placed upon a plentiful use of bark. 
Whether or not opiates act in the cure of gangrene as 
antiseptics, is not, or perhaps, cannot be ascertained. 
I rather believe that they do not: and I am inclined to 
think that they prove serviceable only by allaying irri- 
tation. In this manner they may be employed with 
advantage wherever gangrene appears to be the con- 
sequence of a high degree of inflammation. By les- 
sening or removing pain they may diminish the cause 
of exertion in the vessels of the part affected, and 
may thus tend to prevent mortification from extending 
so far as it otherwise might do : but I have never known 
them to prove useful where the disease seemed to de- 
pend upon the loss of tone, either of the part itself, 
or of the constitution. 

i 2. 

Of Spasmodic Obstructions of the Urethra. 

IRRITATION of the Urethra, from whatever 
r ause it proceeds, has an evident effect in lessening 
the diameter of the passage. Hence, in cases of stone 
in the bladder, the irritation, and consequent con- 
traction of the urethra, is sometimes so great that a 
staff, even of a moderate size, cannot be introduced. 
Stones in the kidney have frequently the same effect. 
Nay, I have known this contraction of the urethra 

18 



138 OF SPASMODIC OBSTRUCTIONS Ch. III. 

induced by sand passing along the ureters. In like 
manner the irritation produced in the urethra by 
Gonorrhoea, is in some cases so great as to excite con- 
traction of the passage in a very distressful degree. 
I have known the urine so completely obstructed by 
this alone, as to give cause to suspect that strictures 
were formed of the most alarming nature ; in which 
neither staff', catheter, nor bougie, could be introduc- 
ed, but with more force than can ever with safety be 
applied. 

We judge that obstruction, proceeds from this cause, 
when at one time it occurs in a severe degree, and 
soon thereafter, perhaps in the space of a few hours, 
it appears to be entirely or nearly gone. Of this I 
have met witli various instances; in which, from the 
anxiety of the patient, and from suspicion of a more 
inveterate kind of stricture, repeated attempts have 
been made in vain to pass a bougie, and in which the 
stoppage has gone of!' entirely upon the exhibition of 
a dose of laudanum, or rubbing the perineum with 
anodyne balsam. 

As the urethra itself does not appear to be muscu- 
lar, as a small portion of it only can be compressed 
by the muscles of the penis, and as the obstruction of 
Which we are now speaking occurs in parts of the pas- 
sage where these muscles do not exist, it has been im- 
agined that this temporary accession of stricture must 
be owing to some other cause. It may perhaps hap- 
pen that the violent irritation excited by chordee may 
in some instances produce such effusion into the cellu- 
lar parts of the penis as may compress the urethra ; 
and that this may soon be removed by absorption, on 
the irritation by which it was produced being taken 
away. But although this may be the case in a few in- 
stances, I am convinced that it is not a frequent occur- 
rence, and that the urethra itself is endowed with a 
contractile power, by which, for the most part, this 
kind of obstruction is produced. 

Were it to proceed from any kind of effusion com- 
pressing the urethra, the tumefaction thus produced 



SeC. IV. OF THE URETHRA. 139 

would be obvious. Partial circumscribed tumours 
would either be discovered in the course of the ure- 
thra, or the whole body of the pen?? or a considera- 
ble part of it, would be swelled. We do not find, 
however, that this is apt -to happen ; at least, in most 
cases of this kind no tumefaction of the penis is per- 
ceptible. 

This kind of spasm or cramp occurs occasionally in 
every part of the urethra. I have met wlii il w it in 
an inch of the extremity of the gjans, but for tl e m >st 
part it happens behind the scrotum, or nearer the pros- 
tate gland, in the membranous part of the passage. 

In the treatment of Obstruction in the Urethra it is 
a matter of the first importance to determine the cause 
by which it is produced. It is particularly neeessa v 
\o distinguish between obstruction arising frouj spasm, 
and that which proceeds from stricture of the passage. 
In the latter, bougies, as we shall afterwards see, are 
almost the only remedies upon which we can depend, 
while, in cases of spasm, they very commonly do harm. 

In the one they remove the disease by acting as wee - 
ges; in the other they add to the violence of the ex- 
traction by increasing the irritability by which it was 
at first excited. 

As the degree of obstruction produced by spasm 
alone is, in some instances, equal to what usually oc- 
curs from the most obstinate kind of stricture, if is on- 
ly from an exact account of the rise and progress of the 
disease by which we can judge of the difference. 

When the flow of urine has at fiisf been perceived 
to be slightly obstructed, and when this has gradually 
become worse, without ever being in any instance ma- 
terially better, there will be much cause to imagine 
that it proceeds from a cause of a n\ed nature : while, 
on the contrary, however complete an obstruction may 
be, if it came on suddenly, and if it frequently be- 
comes quickly well without any obvious reason, there 
will be no cause to doubt of its proceeding from 
spasm. 

We find too, in obstruction proceeding from causes 



110 OF SPASMODIC OBSTRUCTIONS Ch. III. 

of a more fixed nature, that some pain is always dis- 
covered at one or more fixed points. In some cases a 
degree of hardness is perceived on the urethra being 
pressed at these points; while in others, although no- 
thing can be discovered on external pressure, the pa- 
tient feels a degree of heat and pain, as if the parts 
affected were excoriated, or even ulcerated. Besides, 
in real stricture, a discharge of matter very universal- 
ly takes place from the urethra ; forming, as we have 
ai ready had occasion to see, a very frequent cause of 
Gleet. But in obstruction proceeding from spasm, 
any pain which occurs in the urethra does not proceed 
from one point. It appears to be more diffused ; and 
is seldom in any distressful degree, if it be not by the 
stoppage which it gives to the flow of urine. No par- 
ticular spot is discovered to be hard or sore upon pres- 
sure, and a discharge of matter does not necessarily 
take place in it. 

Spasm, indeed, may be accompanied with a flow 
of matter from the urethra. This will always happen 
where Gonorrhoea or Gleet have previously existed ; 
but it will never, on enquiry, be found to be the cause 
of the discharge. 

The remedies to b^ employed for the removal of 
this variety of obstruction are, warm emollients, ano- 
dynes, blood-letting, blisters, and electricity. Bou- 
gies, in certain circumstances, may be also employed. 

Rubbing the parts affected, whether the perineum, 
or more interior parts of the penis, with warm oil, 
proves sometimes useful. Oil, strongly impregnated 
with camphor, and Goulard's form of the unguentum 
saturninum, when applied warm to the parts affected, 
also tend to remove this cause of obstruction. I have 
sometimes known it instantaneously removed by fo- 
menting the perineum with a decoction of chamomile 
flowers or althea, or by the application of a bladder 
filled with warm water. 

The common anodyne balsam makes an useful ap- 
plication here. The parts in which the spasm is seated 
should not only be rubbed with it, but pledgets im- 



SeC. IV. OF THE URETHRA, 141 

mersed in it should be kept constantly applied to them. 
But one of the most powerful antispasmodics among 
external applications is, a mixture composed of three 
parts of laudanum and one of .aether. 

Frequently, however, little or no advantage is de- 
rived from the external application of anodynes ; while 
opium, given internally, is productive of the best ef- 
fects. Forty drops of laudanum, given by the mouth, 
will often remove a spasm of the urethra that has re- 
sisted every variety of this remedy applied to the 
skin; and when thrown up the rectum, in the form of 
injection, it proves still more effectual in removing 
pain, irritation, and spasm about the anus, and in the 
organs of urine and generation, than when received 
into the stomach. 

Whether this may proceed from the remedy getting 
niore nearly into contact with the nerves of the diseas- 
ed parts, or whatever may be the cause of it, is per- 
haps difficult to determine • but, from much experi- 
ence of their effects, I am convinced, that in all such 
affections, opiates prove most powerful when given in 
this manner. 

In plethoric constitutions blood-letting is often the 
most effectual remedy, not only in carrying off the 
spasm which presently subsists, but in preventing re- 
turns of it in future. Besides the discharge of blood 
from the arm in quantities proportioned to the strength 
of the patient, leeches should be applied along the 
course of the affected parts, and they seldom fail 
where the constitution can support the evacuation, of 
giving very effectual relief. 

From an idea of spasmodic affections proceeding in 
most instances from what is termed a weakness of 
nerves, and from a dread which very universally 
prevails, of all such affections being rendered worse 
by blood-letting, this is a remedy we find very rare- 
ly, employed. But it is proper here, as well as in sim- 
ilar affections of other parts, to observe, that morbid 
irritability may be excited by causes of a very oppo- 
site nature. It sometimes takes place where the con- 



142 OF SPASMODIC OBSTRUCTIONS CI). III. 

stiiution is relaxed and reduced ; and, in such cir- 
cumstances, evacuations of every kind very common- 
ly do barm. But it more frequently happens from a 
state of plethora, in which blood-letting proves the 
most certain remedy, and where opiates, warm bath- 
ins;, and other antispasmodics are often used for a 
great length of time, without any effect resulting 
from them. 

We find from experience, that a stimulus applied to 
the skin proves often useful in relieving pain and spasm, 
in parts that are very deeply seated ; and upon trial, 
the same remedies are sometimes found to remove 
similar affections of the urethra. Obstructions of this 
kind have, in different instances, been relieved by the 
application of volatile liniment, a strong impregnation 
of oil with volatile alkali, to the parts affected. A 
blister applied over the perineum, has in different in- 
stances carried off obstructions of the urethra ; arid 
in some cases where blisters tailed, the disease has 
been completely removed by the application of a warm 
plaster. 

In such cases blisters do not seem to act so much by 
the evacuation which they produce, as by the irrita- 
tion which they excite ; for it often happens that the 
pain and spasm are removed as soon as the skin be- 
comes in any degree uneasy, and long before vesica- 
tions can be formed. Hence, a warm plaster, which 
does not contain such a quantity of cantharides as to 
render it capable of acting as a blister, by keeping up 
a more continued stimulus than blisters, proves, in 
some instances, more effectual. 

Electricity has sometimes proved useful in removing 
spasm of the urethra ; but it requires to be managed 
with caution, otherwise it is apt to add to the violence 
of the disease. In plethoric habits it always does mis- 
chief and ought never to be advised in these till blood- 
letting has been premised. 

1 have 1 ad occasion already to remark, that in this 
variety of obstruction, bougies are very apt to do harm. 
This proceeds from their being pushed with violence. 



SeC. IT. OF THE URETHRA. 143 

when the parts, from being under some high degree of 
irritation, are in a state of strong contraction. This 
ought never, therefore, to be done ; for while the 
parts remain in this situation we seldom succeed ; or if 
w r e do get the bougie passed, it is always from the use 
of more violence than ought to be employed. 

But bougies prove highly serviceable, even in Spas- 
modic Obstructions of the Urethra, when the violence 
of the disease is so far removed that they can be in- 
troduced with ease, and without exciting irritation : so 
that, whenever we find this can be accomplished, 
whether the spasm has been lessened by the use of 
emollients, anodynes, blood-letting, or any other reme- 
dy, it ought always to be advised. Beskles the pres- 
ent relief which it affords, by removing any degree of 
the obstruction which may remain, it tends more ef- 
fectually than any other remedy to prevent a return 
of it. This is particularly the case where spasm is 
conjoined, as sometimes happens, with the more fixed 
kind of obstruction, which we are presently to proceed 
to consider. When this takes place all our other reme- 
dies are to be considered merely as preparative to the 
use of bougies, which, in such circumstances, are 
alone to be depended on for a cure. It must always 
be remembered, however, that bougies are only admis- 
sible when they can be introduced and retained in the 
passage, without exciting much uneasiness. 

In all diseases of the genitals the state of the intes- 
tines require particular attention. So much sympathy 
subsisisbetween these parts that in people liable to ob- 
struction in the urethra, I have known a severe fit 
of the disease induced by a costive stool. Neither is 
much purging necessary or proper. The bowels 
should be kept in such a state as to prevent in itafion, 
as far as it can be done, in the rectum and contiguous 
parts. 



144 OF OBSTRUCTIONS Ch. Ill 



$ 3. 

Of Obstructions in the Urethra from Fleshy Excrescent* 
ces, or Caruncles. 

OBSTRUCTION to the passage of urine has long 
been considered as one of the most distressful, as it is 
one of the most frequent consequences of Clap ; and 
Caruncles, Fleshy Excrescences, or Carnosities, as they 
are sometimes termed, are mentioned by all the older 
writers upon this subject, as the most frequent cause 
of it. 

This idea naturally arose from their perceiving that 
warty substances were sometimes formed within the 
urethra, near to its extremity, similar in appearance 
to those which often occur upon the prepuce and 
glans ; and not prosecuting the subject by opening 
the parts after death, they were led to suppose that the 
more deep-seated obstructions were all of a similar na- 
ture. 

So universally did this opinion prevail, and it was 
so strongly asserted in books, that although it was long 
ago, by some individuals, particularly by Saviard and 
Dionis, supposed to be ill-founded, yet even in our 
times it has been very generally admitted. This is so 
far the case, that in common conversation upon this 
subject, Caruncles are usually considered as the most 
frequent cause of all such obstructions. 

It is now, however, very certainly known that this 
cause of obstruction is an uncommon occurrence in 
the more remote parts of the urethra. Of late years 
this has become a very frequent object of anatomical 
investigation; and I have reason to suppose, from all 
that I have yet heard, as well as from the result of my 
own inquiries, that it seldom exists farther up the ure- 
thra than half an inch or so from the point of the glans. 
Warty excrescences are not im frequently found to- 
wards the orifice of the urethra ; but I have seldom 
seen them, even in this situation, where they did not 
likewise prevail upon the glans and prepuce, 



SeC. IV. IN THE URETHRA, 145 

The obstruction to the flow of urine from this cause 
is seldom considerable ; but^t always occasions much 
anxiety to the patient, from a fear which he is apt to 
entertain of its becoming worse. 

When seated just in the opening of the urethra, as 
sometimes happens, I have, in different instances been 
able to remove them with scissors, and with small lig- 
atures passed round them; but they are seldom so sit- 
uated as to admit of our taking them off in this man- 
ner. Neither are we at liberty to destroy them bv the 
application of escharotics, the irritability of the ure- 
thra rendering this a very hazardous attempt. 

In all such cases we place our chief dependance up- 
on bougies; and, when duly persisted in, they seldom 
fail in effecting a cure. 

Some difference of opinion has arisen as to the man- 
ner in which bougies act in removing these excrescen- 
ces. In strictures of a different kind there is no cause 
for doubt upon this point, as they evidently act entire- 
ly as wedges, and prove useful in proportion to the ex- 
tent of mechanical pressure which they afford; but in 
the cure of Caruncles they have been supposed to act 
chiefly by inducing suppuration upon the diseased- 
parts, and dissolving them in this manner. 

It is obvious, however, that in the cure of these ex- 
crescences, there is something farther necessary than 
the formation of matter, Indeed instances occur dai- 
ly, of their being constantly immersed in matter, some- 
times proceeding from their own surfaces, and at oth- 
er Times from the contiguous parts, without their being 
diminished. I rather conceive that bougies, even in 
this variety of obstruction, operate partly by mechan- 
ical pressure, and partly by exciting inflammation in 
the excrescences. We shall hereafter have occasion 
to see, that some of the remedies employed for the re- 
moval of warts in other parts, prove chiefly useful by 
making them inflame; and as bougies are well caicu- 
lated for this purpose, I think it probable, that while 
they evidently answer a good purpose by the pressure 
which thev afford, they prove likewise serviceable by 

19 



146 tfF OBSTRUCTIONS Ch. III. 

exciting over these excrescences that slight degree of 
inflammation, which, intfhe treatment of common ve- 
nereal warts very commonly makes them drop off. 

i 4. 

Of Obstruction in the Urethra from Strictures, property 
so called; of Bougies, and Fistula in Perineo. 

IN the more fixed kinds of Obstruction, proceeding 
from Gonorrhoea, the diameter of the Urethra is les- 
sened in two different ways. For the most part it is 
diminished by a thickening taking place at some par- 
ticular point in the membrane of the passage itself or 
lather in the corpus spongiosum urethra, in a similar 
manner to what frequently happens in the membrane 
of the nose in cases of catarrh. At other times the 
urethra is drawn together, or contracted, as if a cord 
was tied round it, without any other disease being per- 
ceptible. 

In some cases, again, these two affections are con- 
joined ; and we find, in the same person, the diameter 
of the passage lessened in one part by a mere contrac- 
tion, and in another, by a swelling and thickening in 
the substance of the urethra itself. 

Every part of the passage is liable to strictures ; but 
they are more frequent behind and immediately above 
the scrotum, than in any other part. In some cases a 
single stricture only takes place; but when the disease 
has subsisted for a length of time, we very commonly 
find the passage contracted in different parts. 

Where the urethra is merely drawn together, the 
disease seldom extends, at any one part, above the 
eight part of an inch, but where the stoppage proceeds 
from a swelling of the substance of the urethra itself, 
it sometimes extends to the length of an inch. 

From whatever cause the stricture may proceed, 
we commonly find that the urethra is affected equally 
all round ; but it is very properly remarked by Mr. 
Hunter, that, in some cages, the disease seems to be 



SeC. IV. IN THE URETHRA, &C. 147 

fixed entirely on one side of the passage, in which 
case the canal is thrown over to the opposite side. 

This seems to happen only where the obstruction is 
produced by swelling of the urethra, and not where it 
proceeds solely from contraction. 

Where this unequal diminution of the canal takes 
place, even in one part only, it is obvious that it- must 
add greatly to the difficulty of introducing bougies ; 
and where more than one affection of this kind occurs, 
if they be not exactly opposite to one another, a kind 
of twisting of the passage takes place, which renders 
the passing a bougie impracticable. It must, however 
be admitted, that instances of this are rare. 

It is somewhat remarkable that the formation of 
strictures is often so gradual, that a patient is not sen- 
sible of their taking place till the disease has been of 
long continuance. Being seldom attended with pain 
till the flow of urine is much impeded, any partial de- 
gree of it passes without notice, by which they are apt 
to be rendered much more fixed and permanent than 
otherwise they would be. The patient indeed 1 as sel- 
dom any suspicion of strictures, till the surgeon, for 
his own satisfaction, where Gleet continues more ob- 
stinate than usual, proposes to introduce a bougie. 
Gonorrhoea having given rise to the Gleet, any diffi- 
culty that occurs to the passage of the urine is eons.d- 
ered to arise from the same cause; and thus a great 
length of time often elapses before any such examina- 
tion is made as can with certainty lead to a discovery. 

This proves often, in its consequences, highly dis- 
tressful, and ought therefore to be as much as possi- 
ble guarded against; for strictures, by long continu- 
ance, become much more firm, as well as 'more ex- 
tensive, than they were at first, by which they be- 
come much more difficult to cure. Cases which at 
first would have yielded almost to the first attempt 
with bougies, are, by delay, often rendered so obsti- 
nate that nothing will remove them but the most exact 
application of bougies being continued for a great 
length of time. 



148 OF OBSTRUCTIONS Ch. III. 

In all cases, therefore, in which there is the least 
cause to sus[>ect that strictures may exist, an examin- 
ation should he made with bougies. But as patients 
themselves are apt to be deceived upon this point 
practitioners ought, in every instance, to lead their 
attention towards it. In different parts of this work 
we shall have occasion to see that Gleet is frequently 
kept up by strictures: so that whenever a running 
becomes in anv unusual degree obstinate, if there be 
not some other evident cause for it, a trial with a 
bougie should be proposed. This however, is sel- 
dom attended to; by which much unnecessary trou- 
ble, as well as loss of character, falls upon the practi- 
tioner, while the patient is made to suffer a great deal 
of misery which might have been prevented. 

We have already had occasion to remark that the 
strictures of which we are now speaking are conse- 
quences of Gonorrhoea; but in what manner they are 
produced by Gonorrhoea is perhaps difficult to explain. 
They have been attributed chiefly to ulcers induced 
by the disease, and to inflammation. 

At one period I was induced to suppose, chiefly from 
the information I had from books, that strictures were 
in most instances produced by ulcers. But from more 
frequent opport unities of observing the seat of Go- 
norrhoea after death, I am now convinced that ulcers 
very seldom take place here, by no means so frequent- 
ly as strictures, the disease they are supposed to pro- 
duce. It sometimes indeed happens, that the mem- 
brane of the urethra covering strictures, is found in 
a state of tenderness, or of excoriation, but not com- 
pletely ulcerated. This appears too to be the effect 
of the disease rather than the cause of it. It seems 
to proceed, in some degree, from the tumefaction of 
the membrane of the urethra, which often occurs in 
strictures and in some measure from the acrimony of 
the matter which these very strictures produce. 

When ulcers are met with in Gonorrhoea, they 
are in most instances, I believe, produced by the rup- 
ture, of one or more blood-vessels. If it be not at 



See. IV. PROM STRICTURES, &C. 149 

the very point of the urethra, they never proceed from 
the matter of Lues Venerea. Now we can scarcely 
imagine that any ulcer which the rupture of a blood- 
vessel in the urethra could probably produce, would 
be of such depth or magnitude as to be attended with 
any important consequence of this kind. Neither are 
'haemorrhages from the urethra frequent ; nor have I 
found that strictures have been particularly apt to hap- 
pen, even where haemorrhages have taken place in 
an alarming degree. 

I consider it, therefore, as decided, that strictures 
in the urethra seldom or never proceed from ulcers. 
Inflammation, when violent, may certainly tend to 
produce them ; and I think several instances have 
fallen within my own observation where this actually 
happened. I do not suppose, however, that this is 
Such a frequent cause of strictures as is commonly ima- 
gined, nor do I agree with those who think that in- 
jections often produce them. 

As it was observed, that strictures were, in some 
instances, induced by inflammation, and injections be- 
ing supposed, by those who are prejudiced against 
them, very apt to inflame the urethra, it was long 
ago asserted, and has since by many been believed, 
that they tend more frequently than any other cause, 
to produce strictures. This, indeed, is held forth as 
the most important objection to the use of injections, 
and were it in any degree well founded, I admit that 
it would be a strong reason for laying this remedy en- 
tirely aside ; for however desirable it may be to have 
the running in Gonorrhoea quickly carried of, and 
however efficacious injections may be, no practitioner 
would advise them were it to be with the risk of indu- 
cing such a formidable disease as strictures often are. 

Where strong stimulating injections are unguarded- 
ly used, such a degree of inflammation may thus be 
induced as may be productive of the most obstinate 
strictures. But this is not the fault of the remedy, as 
I have elsewhere observed, being entirely the effect 
of an improper application of it. We might with 



150 OF OBSTRUCTIONS IN THE URETHRA Cb. III. 

equal propriety condemn the use of some of our most 
effectual and safest medicines, merely from an over- 
dose having done harm. 

Instead of injections- being a frequent cause of stric- 
tures, I have much reason to think that they are more 
effectual than any other remedy in preventing them. 
Although I have admitted that strictures are sometimes 
produced by severe degrees of inflammation, I do not 
consider this as a frequent occurrence. Strictures I 
conceive to be most frequently the consequence of a 
state directly the reverse of inflammation. In a great 
proportion of cases they will be found to take place, 
where, either from no injection being used, or from 
some other cause, the discharge has gone on to a very 
unusual length, where all symptoms of inflammation 
were gone long before, and where nothing but a Gleet 
remained. At least this has been very generally the 
result of my observation, and, I believe, it will be 
admitted by all who have paid attention to the point 
in question. 1 therefore conclude from this, as well 
as from the appearances which these parts exhibit on 
dissection, that this variety of obstruction proceeds 
most frequently from a state of morbid relaxation or 
debility, induced in these parts of the membrane of 
the urethra upon which the inflammation at first fixes 
with most violence, and from which the subsequent 
discharge is in a great measure produced. 

Where stricture succeeds immediately to inflamma- 
tion, it appears to be that variety of it in which the 
urethra is compressed, or tied, as it were, with a 
cord : but where it does not appear till the inflamma- 
tion subsides, and the discharge has been of long du- 
ration, the substance of the urethra is found, at those 
parts where the strictures exist, spongy, soft and prom- 
inent, bearing every mark of having completely lost 
its tone. 

r J he existence of this variety of stricture being as- 
certained, and it will not be confounded with any oth- 
er disease where the observations contained in the pre- 



SeC. IV. TROiMf STRICTURES, &C. 151 

ceding parts of this section are kept in view, our next 
object is to fix upon the method of cure. 

While the opinion prevailed of strictures being most 
frequently produced by ulcers in the urethra, as this 
led to the suspicion of their being connected with 
Lues Venerea, mercury was advised in almost every 
instance. Mercurial ointment was regularly rubbed 
upon the seat of the disease, in order to dissolve the 
cause of the obstruction, and the patient was put un- 
der a salivation, witn a view to the safety of his con- 
stitution. 

As this was the prevailing practice of our best sur- 
geons, both here and in other parts of Europe, when 
I entered upon business, I was necessarily led to adopt 
it, but late experience having shewn that mercury is 
never necessary in the cure of strictures I have now 
for many years past lair! it altogether aside. Niy, I 
readily own that I never knew any advantage derived 
from it, while in many instances, when long persisted 
in, it evidently did harm. 

It will not be imagined, that during this late period 
of time, mercury was ever alone depended upon for 
the removal of strictures in the urethra. Bougies 
were then very generally employed ; but mercury, for 
the reason I have mentioned, was always advised along 
with them. Bougies had long been known to practi- 
tioners, but they were so coarsely formed, and their 
application so little understood, that scarcely any ad- 
vantage was derived from them, till Mr. Daran, about 
fifty years ago, brought them into more general notice. 
By forming them with care, and introducing them with 
address, Mr. Daran had the credit of giving us the 
only remedy upon which we can place any depend- 
ence for the cure of strictures. At least we are cer- 
tainly in a great measure indebted to him for bringing 
them into general use. 

It is true that Mr. Daran attributed virtues to his 
bougies which they did not possess. Being much in- 
terested in the sale of them, he wished to throw a mys- 
tery, over their composition. They acted chiefly, he 



152 OF OBSTRUCTIONS IN THE URETHRA Ch. Ill, 

said, by their suppurative qualify : in consequence of 
which, and by the great discharge of matter which they 
produced, tumours, and other causes of obstruction in 
the urethra, were, he alledged, dissolved by them, which 
could never otherwise have been removed. The con- 
fidence with which this was asserted, by a man of Mr. 
Daran's experience, and the considerable discharge of 
purulent-like matter which usually accompanies the 
use of bougies, gave weight to an opinion which at 
last came to be very generally adopted. 

We now know, however, that it is not by exciting a 
discharge of matter that bougies act in the cure of stric- 
tures. Even the mildest bougie we can employ, when 
kept in the urethra for an hour or two, is covered with 
a kind of matter on being withdrawn ; but this happens- 
as readily where the urethra is sound as when it is ob- 
structed in various places, and it proceeds entirely from 
the natural mucus of the passage being increased in 
quantity, and somewhat altered in appearance, by the 
irrigation excited by the bougie. 

Even admitting the obstructed parts to be more par- 
ticularly acted upon, and a greater discharge of matter 
excited from them than from the other parts of the 
urethra, and which Mr. Daran asserted to be the case 
under his management, of the bougie, still this would 
not account for the removal of excrescences ; for we 
know, from daily observation, in other parts of the 
body, that the whole surface of excrescences of a sim- 
ilar nature to those which Mr. Daran supposes to tako 
place here, may be kept in a state of complete ulcera- 
tion, and a great quantity of matter discharged from 
them for a great length of time, without any diminu^ 
lion of their size. 

Bougies, in the cure of these strictures, seem to act 
solely by pressure, and t he support which they afford 
to the diseased parts, If a bougie, of sufficient firm- 
ness, exactly or nearly the size of the urethra in its 
contracted state, be passed at first, and others of a 
larger size afterwards introduced, we know from ex- 
perience, that if done with caution, no harm will ei> 



Sec. IV. FROM STRICTURES, &C 153 

sue, and (bat (he stricture for which it was employed, 
will thus, in a gradual manner, be removed, merely by 
the pressure of the bougie* 

In this view, our chief object in the forming of bou- 
gies should be, to give a firmness sufficient to afford 
support to the parts which we wish to compress, and a 
smoothness and flexibility which will admit of their 
being introduced and retained in the urethra with the 
greatest possible ease. 

Numbers 34, 35, 36, and 37, in the Appendix, con- 
tain prescriptions for bougies of different colours and 
consistences, with some directions for the method of 
preparing them ; but the exact formation of bougies 
being a matter of the first importance, and this being 
only to be acquired by extensive experience, it is bet- 
ter for surgeons to procure them from those whose 
sole profession it is to make them, than to attempt to 
form them themselves. 

Besides the forms of plasters mentioned in these 
prescriptions, other articles have been employed for 
the construction of bougies, particularly cat-gut and 
resina elastica. Of these the latter is by much the best, 
and for all the smaller kinds of bougies, I now 7 find it 
to be preferable to the best bougies of the common 
kind. Even when of the smallest size, it can be made 
of such a degree of firmness as to admit of being push- 
ed with considerable force, which is not the case with 
the smaller kinds of common bougies, which are apt to 
bend, and to become twisted, although introduced 
with much care and attention. 

The great expeiice of bougies of this kind has hith- 
erto prevented them from being so generally known as 
they ought to be: besides, they were at first made so 
soft that they nearly dissolved in the urethra on being 
allowed to remain in it for the space of an hour or two ; 
but this fault is now so entirely removed, that I have 
known them remain in the passage seven or eight hours 
at once, and yet as firm on being withdrawn as when 
first introduced. This renders it a valuable article, 
not only for bougies, but flexible catheters, 

20 



1 54 OF OBSTRUCTIONS IN THE URETHRA Ch. III., 

This resin has one very essential advantage over ev- 
ery composition that has yet been employed for bou- 
gies. It does not crack or break while in the urethra, 
however frequently it may be introduced. When the 
common bougies are prepared with much attention, 
and the composition of which they are formed is not 
too much boiled, they may sometimes be used two or 
three times with safety; but, in most instances, they 
cannot with propriety be introduced more than once. 
Nay, many of them, on remaining: an hour or two in 
the passage, are so much cracked as to excite a great 
deal of irritation and pain even on their first introduc- 
tion, insomuch that I have met with different instances 
where patients had been deterred by this cause alone 
from using bougies, the irritation which they excited 
being so great as to be perfectly insupportable ; while, 
on having recourse to those formed ofresina elastica, 
they were found to create no kind of uneasiness. 

These bougies are formed of fine silk, or linen, dip- 
ped in the resin dissolved in aether. They were ori- 
ginally invented by Mr. Thedn, of Berlin, and now are 
made by different artists in Paris. There is cause to 
regret that the art of forming them is as yet confined 
to a very few, so that our supplies have hitherto been 
both scarce and uncertain. 

In the use of bougies the following are points which 
particularly require attention : 

1. T! ey should be provided in such numbers, and 
of such variety of sizes, that there may be no doubt of 
as many being at hand as in any case may be requisite. 

2. On proceeding to introduce the first bougie, care 
should be taken to fix upon one of such a size as will 
probably pass without exciting much pain. It is better 
at first to have it rather smaller than might be made to 
pass, than be afterwards under the necessity of with- 
drawing it. Of this we may in general judge by the 
size of stream in which the urine is observed to flow. 
It is often indeed found to be forked, and sometimes 
flattened, owing to the form and nature of the strict- 
ure, but, with some attention to this circumstance, we 



Sec. IV FROM STRICTURES, &C. 155 

may, for the most part, be determined in the size of 
bougie that will answer. 

3. The patient should be placed in such a posture, as 
tends, in the most effectual manner, to relax the ure- 
thra. He may either be made to stand, with his thighs 
separated, and his body bent gently forward, or he may 
be laid upon his back, with his thighs not only sepa- 
rate, but raised. He ought, on no account, to be sea- 
ted. In sitting the urethra is apt to be so much com- 
pressed that no space is left for the passage of a bou- 
gie. I have known several unsuccessful attempts to 
pass a bougie from this cause alone. 

4. The surgeon being seated on the right side of the 
patient, should grasp the penis with his left hand, and, 
at the same time should draw it gently forward, so as 
to stretch the urethra to such a degree as may prevent 
it from catching the point of the bougie. With the 
bougie previously well oiled, in his right hand, he 
should insert the point of it into the urethra, when it 
must be passed slowly, though firmly on, till it meets 
with resistance. Neither should he desist at once on 
the stricture being met with. It answers better to 
continue to push on the bougie with a due degree of 
firmness, than to withdraw it immediately, as is often 
done. The first application of a bougie to the obstruc- 
tion, is very apt to excite irritation and spasm, even in 
the stricture itself; and I have often thought that this 
was more easily overcome by pushing the bougie on 
at first than by any subsequent introduction of it. 

5. A knowledge of the force that may with safety be 
employed in passing a bougie, can only be acquired by 
experience. Tne less violence that is done to the ure- 
thra, or to the cause of contraction, the better. It can- 
not, in some cases, be done without pain, but it should 
never be made to force a discharge of blood. When 
blood comes away, the instrument should be instant- 
ly withdrawn ; for when this takes place, we may 
always be certain that some parts have been injured 
which ought not to have suffered, and by contin- 
uing to force on the bougie, that there is a con- 
siderable risk of its forming a new passage for itself 



156 OF OBSTRUCTIONS IN TH3 URETHRA Ch. III. 

6. The distress which ensues from a new opening 
being formed by a bougie is apt to be so great, that no- 
thing should be omitted that can in any way tend to 
prevent it. When there is cause to suspect, from the 
quantity of blood discharged, that the membrane of 
the urethra is injured, the bougie ought not to be again 
introduced for several days ; not till there is reason to 
suppose that the wound in the urethra is healed, for, till 
this takes place, it is obvious that it would be very 
apt to renew the injury. 

7. As bougies ought all to be of a conical form, they 
should not be pushed farther at first than freely through 
the first obstruction, otherwise the contracted part is 
apt to be torn open with too much force. It answers 
better to proceed gradually, and to increase the size of 
the bougie, or to push one of the same size farther on, 
in such a manner, as may avoid every risk of injuring 
the membrane of the urethra. 

It is true that cures will be obtained where bougies 
have been introduced with much violence; where vio- 
lent pain, accompanied with haemorrhage, has been 
excited ; but this is a practice, which, for the reasons 
I have mentivjned, ought never to be adopted. 

8. The bougie being introduced, some attention is re- 
quired to prevent it from slipping altogether into the 
uremia, as well as for retaining it in the depth at which 
it is inserted. We obtain tne first of these objects by 
bending the end of the bougie, which, for this pur- 
pose, should be left at least half an inch out of the ure- 
thra ; and the usual method of retaining a bougie in its 
place, is, by tying a piece of soft cotton thread to the 
end of it, and fixing it with this either directly to the 
penis, by passing it once or twice round about the 
glans, or connecting it to the circular belt of a com- 
mon suspensory bandage. But the most effectual me- 
thod, as well as the easiest, which I have tried, is fit- 
ting the penis with a small bag or pouch of cotton oi- 
lmen. The bougie being int induced with its end 
bent down, the bag must be put over the penis, and 



SeC. IV. FROM STRICTURES, &C. 157 

being fixed with two pieces of tape to a circular belt 
round the body, the bougie is in this manner easily 
retained. 

Common bougies being of no great value, may be cut 
of such a length as to leave half an inch or so, out of 
the urethra, for the purpose of bending down in the 
manner I have mentioned ; but those of the elastic gum 
should be kept of every variety of length, from three 
or four inches to nine or ten ; and being easily formed 
with a knob at the large end, they are thus, in the most 
certain manner, prevented from slipping in. 

When this caution has been neglected, and when a 
bougie is thereby allowed to slip completely into the 
urethra, it is sometimes, by the aukward attempts of 
the patient, forced altogether into the bladder. 

In this situation, it cannot be removed but by cut- 
ting into the bladder, as is done in the operation of li- 
thotomy, and extracting it with forceps. But while the 
bougie continues in any part of the urethra it may be 
taken out by an operation of much less importance and 
hazard. 

When the end of the bougie can be seen, it may with 
some care and attention be laid hold of with a small 
hook, or with narrow-bladed forceps, such as are used 
for extracting stones that fix near to the end of the ure- 
thra. But when it has passed so far in, that it cannot 
be perceived, this method of extraction will not suc- 
ceed. 

In this case it can only be got out by making an in- 
cision upon it directly into the urethra. The skin 
should be first drawn back, when a cut should be made 
through the teguments and urethra at once, of at least 
half an inch in length, when, if the end of the bougie 
can be laid hold of, it may be taken out at this open- 
ing ; or if this be not practicable, it may be pushed 
forward till the end of it passes out at the end of the 
urethra. This may be done either with small forceps 
or pliers, or by sticking a pin into the bougie at the 
opening, and pushing it slowly on. The wound for 
the most part heals easily. 



153 OF OBSTRUCTIONS IN THE URETHRA €1). III. 

10. The circumstances which next require attention 
in the use of bougies are, the time they should be allow- 
ed to remain in the urethra, and the frequency with 
which they should be introduced. 

As bougies act, perhaps, entirely in the cure of stric- 
tures by the pressure which they afford, and prove chief- 
ly useful by the total change of stricture. which they in- 
duce in the parts to which they are applied, they must 
necessarily require a considerable time for effecting 
this. The longer, therefore, that they are retained in 
the urethra, the sooner this will be accomplished. But 
w mile we attend to the removal of the stricture, care 
must be taken to prevent injury by their exciting too 
much irritation. This, indped, is the circumstance by 
which we ought to be chiefly directed. It may be laid 
down as a general rule that bougies may be retained in 
the urethra as long as they excite no pain or irritation; 
while, in every instance, they should be withdrawn as 
soon as much pain is produced by them. 

At first they can seldom be allowed to remain lon- 
ger than half an hour at once; but, on the urethra be- 
ing for some time accustomed to receive them, they 
may, for the most part, be left in it for several hours ; 
and this may be repeated once and again during the 
course of the day. 

11. During the time that bougies remain in the ure- 
thra the patient should be prevented from walking or 
moving more than is absolutely necessary. This is not 
usually attended to with necessary strictness, by which 
many are prevented from deriving that advantage from 
bougies which otherwise they would receive. 

In walking, with a bougie in the urethra, the irrita- 
tion induced by it is at all times considerable ; but this 
more especially, when common bougies are employed. 
The motion in walking is apt to crack and break the 
plaster of which they are formed, which renders their 
surfaces rough and unequal, by which it is obvious 
that much harm must be done. 

12. In order to obtain the advantage of perfect rest 
while bougies are introduced, we are advised by many 



SeC. IV, FROM STRICTURES, &C. 15^ 

to employ them only at bed time, and to allow them to 
remain in the passage during the night. This may an- 
swer when the patient is not liable to nocturnal erec- 
tions, but where these are apt to occur it ought never 
to be permitted. I have known several instances of 
much pain and inflammation induced by it. It may, 
in some circumstances, be more convenient to apply 
bougies during the day, but it is evident that it may 
be done with more safety. 

13. To admit as long a retention as possible of bou- 
gies in the passage, some have alledged, that the pa- 
tient may, with safety, be allowed to void urine while 
they remain in it. I have known this done, and no 
harm ensue, where the urine was passed slowly, and 
with much caution : but I have also known the attempt 
do much harm, and as the trouble of introducing the 
bougie a second time is not equal to the hazard of al- 
lowing it to remain, I always advise it to be withdrawn 
on a desire to void urine taking place. 

Besides the pain and inflammation which want of at- 
tention in this matter is apt to induce, and erections oc- 
curring during the introduction of bougies have like* 
wise this effect, I have known different instances of its 
appearing to lay the foundation of spasmodic affections 
of the urethra, which afterwards proved very obstinate, 
even after the original strictures were removed. 

Id. By gradually increasing the size of the bougie, 
the stricture through which it is passed will at last be 
removed ; but before it is entirely destroyed, it will be 
proper to push forward the bougie, to discover wheth- 
er there is any other cause of obstruction or not, It is 
better, however, not to make the attempt till the open- 
ing through the first is considerably enlarged, when 
it will much more readily succeed. 

Whatever other strictures are discovered, they must 
be managed in the manner we have advised for the 
first; the bougie must, if possible, be made to pass 
through them all, and the size of it gradually increased 
till the urethra is opened to its complete, natural size. 

J 5. In passing bougies for this purpose, it has been a 



160 OF OBSTRUCTIONS IN THE URETHRA Ch. III. 

point in dispute, whether they should be carried the 
length of the bladder, and allowed to remain in it or 
not. I am decidedly of opinion that they should be pas- 
sed completely into the bladder, as soon as this can be 
done, in order to discover the utmost extent of the 
strictures; but 1 also think that they should never be 
allowed to remain in the bladder. The common bou- 
gies are so apt to crack, and pieces of the plaster to 
fall off, that this might very possibly happen from their 
being immersed in urine ; and we all know, that if a 
particle should drop, not small enough to pass off with 
the urine, that it would probably serve as a nucleus 
for a stone. This would not so readily happen with 
bougies of elastic gum; but even these, where there 
is so much hazard, ought not to be trusted, particular- 
ly as there Is no real necessity for it in the management 
of strictures ; for it is found upon dissection, that they 
are always seated anterior to the neck of the bladder. 
They are often in the membranous part of the urethra ; 
but they have, perhaps, never been met with in the 
prostate gland, I mean in the urethra as it passes 
through this gland. 

It must be admitted that the urine is often obstruct- 
ed by affections of this gland ; by inflammation, as 
well as by a more indolent kind of swelling, to which, 
as we have elsewhere had occasion to see, it is some- 
times liable. But this variety of obstruction, instead 
of being removed by bougies, is always injured by 
them. We are sometimes under the necessity of pas- 
sing a catheter, even during an inflamed state of the 
prostate gland ; but this should only be done for draw- 
ing off the urine when it has been completely suppres- 
sed. When the gland has been for some time swelled 
in such a manner as to create a stoppage to the flow of 
urine, it is obvious, from its firmness, that bougies 
cannot remove it, while, by the irritation which they 
excite, they never fail to do harm. 

16. Besides the length of time which bougies should 
be kept inserted daily, it is an object of importance to 
determine at what period they may, with safety, be 



Sec. IV. FROM STRICTURES, &C. 161 

laid aside. This, I must acknowledge, is difficult to 
do, as it depends upon a variety of circumstances with 
which it is impossible, at all times, to be acquainted. 
Even where the stricture is so completely removed 
that bougies pass with ease, and the urine is voided in 
a full stream, the disease is apt to recur if the bougies 
be too soon left off. They should, in every instance, 
be worn for a considerable time after all appearances 
of stricture are gone, and the more obstinate the dis- 
ease has been, the longer they should be continued. 

Even after a patient considers himself as so entirely 
well that he may conceive no hazard to ensue from 
the farther use of bougies being entirely dropped, still 
he ought to have them, at all times, in his possession, 
so as to be able, on the least return of obstruction, to 
employ them instantly. This is a precaution not often 
adverted to, but which ought never to be disregarded 
by any who has suffered in this manner: and I think it 
the more necessary to insist upon it, from several in- 
stances having fallen within my own knowledge of the 
most distressful consequences ensuing from a neglect 
of it. It is more particularly proper for all people, in 
this situation, going upon a journey, to be well pro- 
vided with bougies; for, when from home, they can- 
not always readily meet with them, while, at the same 
time, they are more exposed to the various causes 
most apt to excite a return of the disease. These par- 
ticularly are, exposure to cold and dampness; much 
fatigue, whether on foot, horseback, or in a carriage y 
and excess in wine and spirituous liquors. 

All of these causes act with such certainty in indu- 
cing a return of affections of this kind, that I have 
seldom known them fail where people have been much 
exposed to them ; and, in most instances, their effect 
is perceived soon after their application, I have known 
a person, who, after being completely cured of stric- 
tures, for several years, has been seized with a very 
hazardous and painful return of the disorder, in the 
course of an hour or two after being much exposed to 
a cold, east wind. It is particularly apt to occur from 

21 



162 OF OBSTRUCTIONS IN THE URETHRA Cb. Ill, 

violent exertion on horseback, and from being much- 
overheated with wine; more especially from excess in 
port wine. 

A return of stricture is also apt to arise from the urine 
being;, at any time, too long retained after a desire 
takes place to pass it. This ought always to be guard- 
ed against ; but I also think it right to mention, that 
patients sometimes err in getting into the habit of void- 
ing urine too frequently. By yielding immediately to 
every impulse, such a habit takes place that they are 
apt, from this cause alone, to continue, during life, to 
pass it every hour or two. This proves not only very 
inconvenient, but it is also apt to induce a contracted 
state of the cavity of the bladder, together with a 
thickening of its coats, its full distension, which natu- 
rally ought to occur from time to time, being thereby 
prevented. Hence it is a matter of no small impor- 
tance for patients, in this situation, to observe as just 
a medium as can be done between the two extremes 
w hieh we have mentioned. 

On the least return of stricture being perceived, 
whatever the cause may he, a bougie should be imme- 
diately introduced. The patient, if he is plethoric, 
should be blooded in proportion to his strength; his 
bowels should be opened with a gentle laxative, or 
with a clyster; and lie should be kept in bed till the 
violence of the disease be removed. In this manner 
I have known the most formidable attack soon carried 
off, while, from treating them with inattention, even 
the most trifling symptoms have been rendered severe, 
and in the highest degree obstinate. 

The sudden and unexpected manner in which pa- 
tients are often attacked with a return of these affec- 
tions, has given cause to suspect that they must, in such 
instances, proceed from spasm. But the obstinacy 
with which they often continue, as well as every other 
circumstance attending them, renders it obvious, that, 
in a great proportion of cases, they proceed from caus- 
es of a more permanent nature than spasm is almost 
ever found to be. 



Sec. IV. FROM STRICTURES, &C. 163 

17. We have hitherto been supposing that the stric- 
tures are of such a nature as to permit a bougie to be 
passed with no great difficulty ; in which case, no doubt 
can.be entertained of our being able, by perseverance, 
either to accomplish a cure or to afford at least very 
effectual relief, and to prevent any alarming obstruc- 
tion from taking place to the passage of the urine ; for 
however bad a stricture may be, if bougies of a small 
size can be passed at first, we may always be able, as 
I have already observed, in a gradual manner, to in- 
troduce those of a larger size. But frequently, either 
from the passage being contracted to a very small size, 
or from the stricture being altogether on one side of 
the urethra, by which the passage is thrown over to 
the opposite one, after a variety of attempts we find 
no progress made, or if any thing is gained, it is so in- 
considerable as to afford no kind of relief. This proves 
always very dispiriting to the patient, and is apt to dis- 
pose practitioners not much versant in this branch of 
business to desist from all further trials: considering 
the disease to be incurable, they prescribe a course of 
palliatives, which, for the most part, avail little, while 
the oaly remedy from which advantage could be ex- 
pected is deserted. 

This ought never to be done, at least it ought never 
to come on the part of the practitioner, nor can any 
thing warrant the measure but the patient himself be- 
ing determined against the farther application of bou- 
gies. This, from impatience and disappointment, is 
apt to happen; but it ought at all times, to be as much 
as possible resisted. Even in the most obstinate ob- 
struction that occurs, if the passage be not altogether 
obliterated, a surgeon of experience will scarcely fail, 
if he be not prevented by the impatience or timidity 
of his patient from persevering for a due length of 
time. 

18. When there is cause to suspect that the passage 
is thrown over to one side of thcurethra, by the stric- 
ture being fixed in the other, a point in which we may 
sometimes be determined by external examination with 



164 OF OBSTRUCTIONS IN THE URETHRA Ch. III. 

the fingers, and most frequently by the feelings of the 
patient, the extremity of the bougie should be slightly 
curved or bent before being inserted, and the point of 
it being turned towards that side where the passage is 
understood to be, if carried on in this direction, we 
will sometimes succeed, when various attempts have 
failed in the usual manner. It will be readily suppo- 
sed that the curvature given to the bougie must be ve- 
ry inconsiderable ; but even the slightest will some- 
times give it the direction which we wish it to take, 
while it does not prevent it from passing, with suffi- 
cient ease, along the urethra. 

19. In the introduction of a bougie it ought to be 
kept firm between the finger and thumb of the right 
hand, and pushed gradually forward till it reaches the 
stricture; but, when it has got this length, it common- 
ly answers better to twirl it between the finger and 
thumb, taking care to push it gently forward at the 
same time. At least I often succeed in this manner 
when the usual method of pushing it directly on, has 
failed. 

20. I have already observed that no more force 
should be used in the introduction of a bougie than is 
merely necessary for making it pass ; but it is proper 
to remark, that, in the hands of a surgeon of experi- 
ence, much more force may with safety he applied 
than others can, with any propriety, venture to em- 
ploy. By pushing a bougie slowly and gradually for- 
ward, we often force it through strictures without any 
discharge of blood taking place, while much pain and 
laceration is sometimes produced even by less violence, 
when applied in a hurried or quick manner. 

21. When we find upon trial that a small bougie, 
nearly the size of the opening, is made to pass, no 
force will be afterwards required, if the bougies be 
gradually increased in size. But when we find upon 
repeated trials, that the remaining passage cannot be 
discovered, and when we therefore mean to employ 
more force, a bougie of greater strength should be 
used in place of the smaller one. The small-sized 



SeC. IV. FROM STRICTURES, &c. 165 

bougies, particularly those of the common kind, are 
so easily bent that they should never be employed 
where much force is required. I have known even 
surgeons of experience push forward bougies of this 
kind, and concluding that they had passed the stric- 
ture, have carried them on till they imagined they had 
nearly reached the bladder, when, on being withdrawn, 
they were twisted up in the form of a corkscrew, hav- 
ing never gone farther than the stricture. 

With a firm, well-polished bougie of elastic gum, 
well rounded at the end, and not smaller than a crow's 
quill, such a force may be applied as will often suc- 
ceed when no advantage can be derived from those of 
a smaller size ; and we should not be deterred from 
proceeding, although the first trials prove unsuccess- 
ful ; for we often pass the stricture by perseverance 
when no advantage was gained at first. 

I have reason, indeed, to imagine, from what has 
happened in the course of my own practice, that few 
cases will occur which may not ultimately be cured by 
bougies. But when they do, in what manner are we 
to proceed? When every trial that we dare venture 
upon with bougies fails, what are we to do ? This, it is 
evident, must depend entirely upon the state of the 
parts affected, and upon the degree of obstruction 
which takes place. 

If there is still such an opening left as admits of the 
urine passing off with tolerable ease, I would advise 
nothing farther to be done. A patient, in such a situ- 
ation, had better submit to the inconvenience of pas- 
sing it slowly, and even frequently, than to the ope- 
ration of removing the stricture, which consists in lay- 
ing the obstructed part of the urethra open, and in the 
frequent introduction of a bougie during the process 
of the reunion of the divided parts. This, however, 
is an operation of much importance : it is attended 
with so much pain, and with such uncertain success, 
that no practitioner of experience would recommend 
it while the urine is not totally obstructed ; and long 
before this could probably happen the situation of the 



166 OF OBSTRUCTIONS IN THE URETHRA Oil. III. 

parts lying between the stricture and the bladder is 
commonly such as to induce the patient to submit 
more readily to any operation that may be necessary, 
than he ever would have done in a more early stage 
of the disorder. Whenever the stricture occasions 
much difficulty to the flow of urine, that part of the 
urethra lying between the stricture and bladder, is ne- 
cessarily distended on every attempt to void urine. 
This frequent stretching at last weakens the lining 
membrane of the urethra; the urine is at first in small 
quantities, and afterwards in larger, forced into the 
surrounding cellular substance: this, forming one or 
more small tumours, at last bursts out through a cor- 
responding number of openings, either in the perine- 
um, or in the cellular part of the scrotum. At least 
this is the usual progress of such tumours when the 
strictures in the urethra, by which they were produced, 
cannot be removed. 

This is the most frequent cause of the disease we 
have already had occasion to mention, Fistula in Pe- 
rineo, in which the urine continues to flow out at the 
newly forced openings, as long as the strictures in 
the urethra are allowed to remain and which accord- 
ingly, as we have already observed, makes the pa- 
tient easily submit to whatever may be necessary for 
removing them. In such circumstances nothing will 
prove successful if the diseased parts be not freely 
laid open. A stalf being introduced the length of the 
stricture, and a small probe passed in at one of the 
openings, and carried to the opposite side of the stric- 
ture, the intermediate space should be laid open by an 
incision in the direction of the urethra. In this man- 
ner the cause of obstruction will be discovered and re- 
moved, and the other sinuses communicating with the 
urethra being likewise laid freely open, a cure even 
of the worst cases that occur, may thus be frequently 
obtained. To enter more fully into the consideration 
of this operation, and of the after treatment of the 
sores, would here be improper, as it w T ould extend 
this article to too great a length. It could not be done 



§eC. IV. FROM STRICTURES, &C. 16? 

with precision and clearness without entering upon the 
general doctrine of fistula, and upon different methods 
of cure that have been proposed for it; and as this 
has been done in a different work, I must now refer to 
what I had then occasion to say upon it.^ 

Before concluding the consideration of strictures in 
the urethra, I think it necessary to notice a method of 
cure that has been proposed where we fail in the in- 
troduction of bougies, the repeated introduction of 
caustic into the urethra, with the view of destroying 
the cause by which the stricture is produced. 

This practice prevailed upwards of a hundred years 
ago, but was soon relinquished. It has lately, how- 
ever, been revived, or rather a proposal made for re- 
viving it, by Mr. Hunter of London, under whose di- 
rection, it is to be hoped that it will soon become as 
generally useful as we can ever expect it to be. But 
as T consider this practice as more or less hazardous, 
and not likely to prove often effectual, T shall briefly 
state what leads me to form this opinion, that others 
may be on their guard against too implicit an adop- 
tion of it. 

The introduction of caustic into the urethra must 
prove hazardous from two circumstances, our not be- 
ing able, even with all the pains we can take, to ap- 
ply it to the stricture alone, without injuring the con- 
tiguous parts of the urethra, and the risk which there 
must always be of some small portion of the caustic 
breaking off and being left in the passage. 

Mr. Hunter has indeed invented a very neat appa- 
ratus for the introduction of caustic. It consists of a 
silver tube, open at both ends, nearly the thickness of 
a common catheter, with a port-crayon, somewhat 
longer than the tube, into which the caustic is fixed. 
A stillette, with a perfectly round end, is first passed 
through the tube, and if it be exactly fitted to the end 
of it, the two together may be carried with perfect 
ease along the urethra till they come in contact with 

* V. S}-stem of Surgery, chapters xv. and xx, 



168 OF OBSTRUCTIONS IN THE URETHRA Cll. III. 

the stricture, when the stillette to be withdrawn, and 
the port-crayon, with the caustic fixed in if, introdu- 
ced. The caustic being applied to the stricture for 
about the space of a minute, must be withdrawn along 
with the instrument, and this must be repeated every 
two or three days till the cause of obstruction is re- 
moved. 

This, from description, appears perfectly simple, 
and of easy execution : but notwithstanding the ingen- 
uity of the invention, it is obviously liable to the two 
objections which 1 have mentioned. We know even 
where parts are uncovered, and therefore immediately 
under view, that it is exceedingly difficult to destroy 
diseased parts with caustic, without injuring the con- 
tiguous sound parts. In the urethra, therefore, where 
we receive no advantage from the eye, and where the 
slightest deviation of the instrument may fix the caus- 
tic upon the urethra itself, instead of the stricture, 
there must evidently be a good deal of hazard from 
this circumstance alone, independent of the chance of 
injuring the contiguous parts merely by the spreading 
of the caustic, admitting it to be applied with all man- 
ner of exactness. 

Besides, as the size of caustic that can be passed in 
this manner is necessarily very small, there must always 
be some hazard of its dipping out or breaking off, an 
occurrence from which the highest degree of distress 
w ould ensue ; for it could not be extracted, and dilution 
could not be employed with such effect as to prevent 
it from doing a great deal of mischief. 

Another very important objection occurs to this 
practice. A great proportion of all strictures, perhaps 
nearly ninety of a hundred, are seated beyond the 
curve of the urethra, to which an instrument sostreighfc 
as a tube acting as the conductor of another body 
ought to be, cannot be carried. But Mr. Hunter, fore- 
seeing the difficulty, has endeavoured to remove it by 
proposing that the end of the tube should be flexible, 
and of the same form with the common flexible cathe- 
ter of silver. But this, while it apparently adds to the 



Sec. IV. FROM STRICTURES, &C. 169 

ingenuity of the invention, renders it evidently more 
hazardous. The small point of caustic contained in 
the port-crayon will be more apt to be broken 01 loos- 
ened in passing through a curved tube than through a 
straight one, while it will not be possible to apply it 
to any one point with such firmness and steadiness. 

But even admitting that caustic may with safety be 
conveyed to strictures in the urethra, yet, in those cases 
which do not yield to the use of bougies, tie obstruc- 
tion is generally of considerable extent, and the quan- 
tity of caustic necessary for removing it so gteac trat 
the contiguous sound parts of the passage must be 
much injured, whatever care and attention we bestovr 
in the application of so active a remedy. On these 
accounts, it would appear, that for the removal of 
strictures in the urethra, the application of caustic is 
either impracticable or unsafe. In all slight obstruc- 
tions of the urethra, a 0- , forte may be used 
with bougies, sufficient ior removing them. YV henever 
this can be done, no person will doubt of the pro- 
priety of preferring them to the use of caustic ; and 
when the cause of obstruction is of such extent as to 
render cur attempts with bougies unsuccessful, there 
will be little or no room to hope that caustic will an- 
sner the purpose. In other parts of the body we all 
know how difficult it is to remove even the callous 
edges of an ulcer with caustic. Nay, in many in- 
stances, new parts seern to form before the eschar pro- 
duced by the previous application of the caustic has 
come oft. I have no hesitation, therefore, in saying, 
that in similar affections of the urethra, proceeding to 
the extent which we here suppose them to do, caustic 
would either be altogether inadequate for the purpose, 
or must be applied in such quantities as would be at- 
tended with a great deal of hazard. 

In all such circumstances, I consider it as preferable 
to let the disease take its usual course. The worst that 
can happen is, the formation of sinuses behind the 
strictures, and the discharge of urine from the open- 
ings which these produce. Few patients incline long 

22 



270 OF OBSTRUCTIONS IN THE URETHRA Ch. Ill, 

to submit to this ; but I consider the cure of this state 
of the disease, by the mode of treatment already 
pointed out, as more certain, while it is obviously 
much less hazardous than the means proposed for pre- 
venting it by the application of caustic. 



Since the time our author wrote on the subject of Stricture, 
a very important improvement in the method of treating them has 
been introduced, viz their destruction by the use of caustic. We 
do not mean to say ti.at its use is entirely novel, as we knew that a 
variety of caustics were used by the older surgeons, as Daran, Paree, 
Hildanus, Astruc, and others, who used Lunar Caustic, Lapis- 
infernalis. Red Precipitate, &.c. ; but that the use of it is now re- 
duced almost to a system, by which we can frequently relieve this 
most troublesome complaint in one tenth part of the time, that is 
required, in the use of the merely mechanical remedy, the bougie. 
For the revival at least, of this method of treating strictures, we 
are indebted to the ingenious Mr. J. Hunter, whose repeated fail- 
ures in the ordinary method, ^by the bougie,) induced him to at- 
tempt their destruction by the caustic ; and had he been as success- 
ful in the mode of applying, as he was judicious in the choice of 
the application, he would have left little for his successors to do, 
at least, in those cases ol stricture to which this method of treat- 
ment is applicable. Fortunately, wtiat the Z'_ai of Mr. Hunter did 
not accomplish, has been atchieved by the science and perseverance 
of some modern surgeons, at the head of whom we must unques- 
tionably place Mr. Home, surgeon to St. George's Hospital, Lon- 
don. We cannot pretend to give even an outline, of Mr. Home's 
" Practical Observations on the treatment of stricture in the ure- 
thra, &c." in the short compass ot a note ; yet we cannot refrain 
from abridging some of the practical maxims which they contain, 
as a hint to those who unfortunately do not possess the entire 
work. 

Of Strictures properly so called, there are three kinds, viz. the 
true or permanent stricture, arising from an alteration in ihe 
structure of a part of the urethra, the mixed, or that in which the 
former is combined with spasm, and lastly, what has (perhaps im- 
properly) been termed he true spasmodic stricture. The first of 
these species most unequivocally demands the use of the caustic, and 
in such cases Mr. Home makes use of the lunar caustic (nitrate of 
silver) which he applies in the following manner. " He takes a 
bougie which can be easily passed down the urethra to the stricture, 
and inserts a piece of lunar caustic into the end of it, in such man- 
ner, that while the caustic is even with its surface, it is surrounded 
every where literally by the substance of the bougie." This he 
directs to be clone some time before it is to be used, in order that 
Ihe soft materials of which the bougie is composed may have time 
to fix more firmly about the caustic, and prevent its slipping cut ; 



Sec. IV. FROM STRICTURES, &C. 171 

when prepared in this way, it is oiled and is then ready for use. 
The bougie thus armed, is used in the following manner, a common 
bougie of he same size is passed down to the stricture, in order to 
clear the canal, and to measure the exact distance of the stricture 
from the orifice of the urethra This distance being marked upon 
the armed bougie, it is to be passed down to the stricture, as soon 
as the other is withdrawn. The caustic in its passage is scarcely 
allowed to come into contact with any part of the membrane, be- 
cause the point of the bougie, of which the argentum mVatum 
forms the central part, always moves in the middle line of the canal ; 
and indeed the quickness with which it is conveyed to the stricture, 
prevents any in-jury of the membrane lining the passage, when the 
caustic accidentally touches it. 

In this mode the caustic is passed down with little or no irrita- 
tion to the lining of the urethra, it is applied in the most advanta- 
geous manner to the stricture, and can be retained in that situation, 
sufficiently long to produce the desired effect. 

The arguments in favour of this mode of treatment over that by 
common bougies, are first, that a permanent cure is effected, which 
is seldom the case when the common bougie is only used ; secondly 
that the application produces little 01 no pain, and that inflamma- 
tion, a common consequence of the application of the common 
bougie, does not ensue. 

It is not pretended by Mr. H. that every stricture is curable in 
this manner, but that in all cases, which have come under h : 'S 
care, in a very extensive practice, it has proved the most efficacious, 
and even in cases where it failed of effecting a cure, that it was at- 
tended with no bad consequences. 

In the application of the caustic to the second or mixed species 
of stricture, Mr. Home claims the merit of originality, and observes 
" having met with a number cf facts, from which a general principle 
appears to be estabiisned, chat the irritable state of a stricture is 
ke^t up, and even increased, by the use of the bougie, but lessen- 
ed and entirely destroyed by the application of lunar caustic ; 1 ana 
desirous to communicate my observations upon these facts, and to 
recommend tne use of the caustic, in many cases of irritable strict- 
ure, in preference to the bougie. As the use of the caustic upon 
this principle is I believe, entirely new, and is contrary to every no- 
tion that had been formed upon the subject, it will require some- 
thing more, than general assertion, to gain even the attention of 
many of my readers, still more their belief ; I shall therefore detail 
the circumstances, as they occurred, by which I conceive the pro- 
priety of this practice, to be established ; and afterwards make some 
observations, upon the principle on which it depends" 

Mi\ Home proceeds, " ray connection with Mr. Hunter, afforded 
me opportunities of attending to cases of stricture, in all their 
different sta-es ; many of tnem brought on during along residence 
in India, attended with great irritability, and exceeuinglyclifncu.it of 
cure.'' 



372 OF OBSTRUCTIONS IN THE URETHRA Cb. III. 

One case of this kind admitted the passing of a small bougie ; 
but. in the course of three years, very little was gained by a steady 
perseverance in the use of that instrument, either in dilating the canal, 
or palliating the symptoms of stricture ; this made me loot upon ihe 
bougie as Kss efficacious, than I had always been taught to believe it. 
I was willing, however, to consider this as an uncommon case, de- 
pending more on the peculiarity of the patient's constitution, than 
on the nature of the disease : but I found on a particular enquiry, 
that several other gentiemen from India, were under circumstances 
nearly similar; the bougie only preventing the increase of the 
stricture, but being unable to dilate it beyond a certain size; and 
was left oft*, the stricture in less than two months returned 
to its' former state of contraction. What plan ought to be followed 
in such cases, I was then unable to determine ; but, that the bougie 
e aid not be depended on was evident. During this suspense, the 
following case came mader my care. 

In August, 1794, a gentleman consulted me, for some symp- 
toms which had been considered as indicating the presence of Gon- 
orrhoea; but as they did not yield to the common treatment in the 
usual time, he was induced to take my advice respecting the nature 
of is cmpiainc. In the necessary enquiry, to obtain a perfect 
his >ry of the case, among other things it was stated, that, nineteen 
years before, there was a stricture, which became very trouble- 
Some, and tlfet Mr. Hunter, by the desire of the patient, had appli- 
ed the caustic, by which the stricture was removed, and never 
afterwards returned. He said that he was one of the first per- 
sons, on whom the caustic had been used. From this account, I 
TYas naturally led to believe, that the stricture had gradually re- 
turned, and was now increased so much as to produce the present 
symptoms ; a discharge being almost always a symptom of stricture 
wnen it is much contracted : but, upon examining the canai a bougie 
of a full size passed on to the bladder without the smallest im- 
pediment. I therefore took up the case as an inflammation in the 
uretr.ra; and hrge doses of the balsam copaibse effected a cure. 
The circumstance of a stricture having been removed nineteen 
years before, and not returning, made a strong impression on my 
mind; and made me desirous to ascertain, Whether this practice 
couid be employed in cases of stricture if \ efrerftt, and the cure 
prociuced by it." equally permanent. A short lir for wards I had 
an opportunity of trying it in the following case. 

A captain in the Ease India company's service, in Sept 1794, 
applied to me for assistance. His complaints were, great irritation 
in the urethra and bladder, constant desire to make water, and an 
inability to v >id it, except in very small quantities. These symp- 
toms had been at first supposed to arise from Gonorrhoea, after- 
wards rendered more severe by catching coid ; but not yield- 
ing to the usual remedies for Gonorrhoea, they were investi- 
gated more minutely and a stricture was discovered in the urethra, 
ffne mode of treatment was now changed, and the bougie employ- 
ed \ but, its use aggravated all the symptoms, ana brought on so 



SeC. IV. FROM STRICTURES, &C. 173 

great a degree of irritability on the bladder and urethra, that there 
-was an alarm for the patient's life which was the reason for applying 
for my assistance. 

Besides the local symptoms, this patient had those of quick pulse, 
white tongue, hot and dry skin, loss of appetite and total want 
of sleep, with frequent attacks of spasm on the bladder and ure- 
thra. A very small flexible gum catheter was passed, and the 
water drawn off, in quantity about a pint, which gave him great re- 
lief ; this was repeated morning and evening, to keep the bladder 
in as easy a state as possible ; but, in other respects he continued 
much the same. 

As the present symptoms were brought on by the use of the 
bougie, little good was to be expected from that instrument ; and 
when the urethra had been so easily irritated, and was disposed to 
continue in that state, there was no prospect of the bougie after- 
wards effecting a cure. These circumstances I explained to the 
patient ; and mentioned, in proof of my opinion, the case, in which 
so little had been effected in three years. 

I then proposed to him a trial of the caustic, with a view to 
deaden the edge of the stricture, as the only probable means of 
effecting a cure. The degree of irritation was already great ; I was 
however, led to believe, that the application of the caustic would 
not increase it, since by destroying the irritable part, it might les- 
sen, and even remove the spasmodic affection ; but if, contrary to 
my expectation, the irritation continued, we still should be able to 
draw off* the water, as the slough formed by the caustic, would pre- 
vent the edge of the stricture from acting, and obstructing the in- 
strument. The application of the caustic was upon these grounds, 
determined on ; and it was applied in the following manner. 

I passed a common bougie, nearly the size of the canal, down 
to the stricture, to ascertain its exact situation, and to make the 
canal of the urethra as open as possible. The distance was then 
marked upon a bougie armed with caustic, of the same size, which 
was conveyed down as quickly as the nature of the operation would 
admit. It was retained upon the stricture, with a slight degree of 
pressure ; at first there was no pain from the caustic, but a sore- 
ness from pressure j in less than a minute, a change was felt in the 
sensation of the part, it was at first a heat, succeeded by the burn- 
ing pain peculiar to caustic ; as soon as this was distinctly felt, the 
bougie and caustic were withdrawn, having remained in the urethra 
about a minute altogether. The soreness he said was entirely local, 
by no means severe, was unaccompanied by irritation along the 
canal, and he thought the uneasiness in the bladder diminished by- 
it. He described the pain as resembling very exactly the first symp= 
toms of Gonorrhoea. Tnis sensation lasted half an hour after with- 
drawing the bougie. 

The caustic was applied in the forenoon, and he passed the day 
more free from irritation, than he had been since the beginning of 
the attack, which had lasted six days. In the evening the water 
v/as drawn off with more ease ? than, the night beiore. He passed a 



174 OF OBSTRUCTIONS IN THE URETHRA Cb. III. 

tolerable night, and the next day continued free from irritation. On 
the third day, the caustic was again applied in the forenoon ; the 
painful sensation was less, than on the former application, lasted a 
shorter time, and in an hour after the armed bougie was withdrawn, 
he made water freely, for the first time since the commencement 
of his indisposition. He said the irritation in the bladder was re- 
moved, and he felt very well. His appetite returned, he siept 
very well, and continued to void his urine with ease. In this state 
nothing was done till the fifth day, leaving always a day between the 
applications of the caustic. On this day a common sized bougie went 
readily into the bladder ; it was immediately withdrawn, and the 
cure was considered as complete ; no bougie was afterwards pass- 
ed, lest it might bring back an irritation upon the passage. I met 
this gentleman twelve months after, and he assured me, he had 
continued perfectly well, and I have since learned, that, in three 
years there has been no return. 

The result of this, and some other cases, induced Mr. H. to 
adopt it, as his general practice in strictures : He does not pretend 
Iiowevev, that it will answer in every case, and it is well known that 
in some irritable cases it is altogether inadmissable ; in gouty dis- 
posed persons, it has induced a fit of the gout : in persons who have 
been afflicted with intermittents, it has excited a return of that 
complaint, and both of these disorders have been brought on by the 
use of the caustic, in so distressful a degree, that it was impossible 
to repeat the remedy. 

As the arming of the bougie, is a matter of very great im- 
portance, and as the mode already described, is occasionally liable 
to the unpleasant accident of leaving the caustic in the urethra, we 
insert from Mr. Home, the process pursued by a Mr. Puss of 
London, in the preparation of bougies for this operation. u In 
forming the bougie, a piece of wire of the size of the caustic is rolled 
up along with it, passing into the substance for half an inch ; when 
the bougie is nearly finished, the wire is withdrawn, and the caustic 
inserted in its place ; after this the bougie is rolled again, so that the 
sides of the caustic become firmly cemented to the linen, by means of 
the composition of the bougie, and when cold cannot be separated 
by any force. In this way bougies are now generally armed." The 
caustic should not be applied oftener than once every other day, 
unless in very obstinate cases, in which Mr. Home observes, he has 
applied it daily, without detriment. 

The preparative bougie, or the one first passed down in order, 
to ascertain the seat, size and shape of the stricture, is termed by 
Mr. Home the soft bougie, and is made of oii, wax, and resin, in 
such quantities, as to render it sufficiently firm for introduction, yet 
yielding enough to receive an impression from the stricture into 
which it is passed. It should be of a light colour, that these im- 
pressions may be more custinctly seen. 

When the soft bougie passes through the stricture, by leaving 
it in the canal a few minutes it can be known whether the stricture 
is completely destroyed or only relaxed ; in the last case there is 



SeC IV. FROM STRICTURES, &C. 175 

an impression on the side of the bougie. So necessary is the infor- 
mation acquired in this way, says Mi\ Home, to enable the surgeon 
to prosecute the cure of stricture by means of the caustic, that 
without it I should have been unable to pursue this mode of prac- 
tice. I should have wanted a sufficient degree of confidence to car- 
ry me on, which nothing but an accurate knowledge of what had 
been already done, couid ha\e given, and, in no other way, is that 
to be acquired. 

We offer these as a few of the more important practical remarks, 
and directions, contained in Mr. Home's Treatise on Strictures, &c. 
It is however but a very imperfect hint, and we cannot leave his 
work without recommending it to the most serious and attentive 
perusal of every surgeon ; being perfectly satisfied that no abridg- 
ment of it can clo justice either to the work itself or its author. 

Mr. Whately, another surgeon, to whom we are much indebted 
for many valuable communications on different subjects, has also 
furnished us with a treatise on strictures, in which he maintains, 
that they are not merely a contraction of the fibres of the urethra, 
but actually diseased portions of the membrane lining that canal, 
with a continued disposition to increased contraction, and concludes 
that tire caustic is a remedy calculated to remove the diseased affec- 
tion, and to dilate the contracted part, effecting a perfect cure, 
without the troublesome and painful inconvenience of wearing a 

Mr Whately does not, however, use the nitrate of silver as re- 
comm ended by Mr. Home, but states, that he has discovered in the 
kali purum, a most efficacious and valuable substitute, for that 
pai tin application ; indeed he considers it more efficacious as well 
as less painful and hazardous. When it is determined that the use 
of this remedy is admissible, the following are a summary of his 
directions for its application, viz " Put a small quantity of kali 
purum upon a piece of strong paper, and break the bit of caus- 
tic with a hammer into small pieces of about the size of large and 
small pins' neads. In doing this, care should be taken not to reclece 
it to powder. Thus broken, it should be kept for use in a phial, 
closed with a ground stopper. The bougie should have a proper 
degree of curvature given to it, by drawing it several times between 
the finger and thumb of the left hand. 

Mr. Wnately next acquaints us, that before the caustic is insert- 
ed into the bougie, it is necessary to ascertain the exact distance of 
the stricture, (to whica the caustic is to be applied) from the ex- 
tremity of the penis. For this purpose, the bougie, which should 
be just large enough to enter the stricture with some degree of 
tLhtness, ought to be gently introduced into the urethra ; and 
when its point stops at the stricture, which it almost always does, 
before it will enter it, a notch is to be made with the finger-nail, on 
the upper or curved portion of the bougie, on the outside of the 
urethra, exactly half an inch from the extremity of the penis. 
Wnen the bougie is withdrawn, a small hole, about the sixteenth 
part of an inch deep, should be made at the extremity of its round- 
ed end. A iaige biaiiKet-pin two inches and a halt in length, with 



176 OF OBSTRUCTIONS IN THE URETHRA Ch. III. 

the head struck off, will answer the purpose ; the hole being made 
with the point of the pin. The extremity of the bougie should 
then be made perfectly smooth with the finger and thumb, taking 
care, that, in doing this, the hole in its centre be not closed. Some 
of the broken caustic should then be put on a piece of writing 
paper, and a piece less in size, than the smallest pin's head, 
should be selected ; the particle, indeed, says Mr. Whately, can- 
not be too small for the first application. Let this be inserted into 
the hole of the bougie with a pocket-knife, spatula, or some such 
instrument ; and pushed down into it with the blunt end of the pin, 
so as to make the caustic sink a very little below the margin of the 
hole. To prevent the kali from coming out, the hole should then 
be contracted a little with the finger, and the remaining vacancy in 
it is to be filled with hog's lard. This last substance (continues 
Mr. Whately) will prevent the caustic from acting on the sound 
part of the urethra, as the bougie passes to the stricture. When 
the bougie is quite prepared, let it be first oiled, and immediately 
afterwards introduced, by a very gentle motion, with the curvature 
upwards, as far as the anterior part of the stricture, upon which the 
caustic is to be applied. In doing this, the end of the bougie, that 
is held by the finger and thumb, should be a good deal inclin- 
ed towards the abdomen, on the first introduction of the instru- 
ment, in order to preserve its curvature. After it has passed about 
five inches, this end should be gradually brought downwards, as 
the bougie passes on, till it forms a right angle with the body. 
The bougie is known to have arrived at the stricture by the resist- 
ance made to its progress. 

As soon as the bougie has reached the anterior part of the stric- 
ture, it should rest there for a few seconds, that the caustic may 
begin to dissolve. It should then be pushed very gently forward, 
abouL one eighth of an inch ; after which, there should be another 
pause, for a second or two. The bougie should then be carried for- 
ward in the same gentle manner, till it has got through the stric- 
ture. The sense of feeling will generally inform the operator 
when the point of the bougie has proceeded so far ; but, the notch 
in the bougie is to be an additional guide, by becoming very near 
the orifice of the urethra, when the end of the instrument has just 
got through the stricture. 

The bougie should now be immediately withdrawn by a very 
gentle motion to the part, at which it was first made to rest awhile. 
Then it should be very slowly passed through the stricture a second 
time ; but, without letting the bougie stop in its passage. If the 
patient complain of pain, or be faint, the bougie should be imme- 
diately withdrawn ; but, if these effects are not produced, we may 
repeat the operation of passing and withdrawing the bougie through 
the stricture once or twice more, before we finish the operation, 
which will take up, in the whole, about two minutes. 

The first application of the kali purum, in this manner, gives, 
according to Mr. Whately's account, a very little pain. A slight 
scalding in making water, and a trifling discharge, during the first 
day or two, however, are commonly produced. 



SeC. IT. FROM STRICTURES, &C* 177 

At the end of seven clays- the application of the caustic is to bs 
repeated in the same manner. When the first application has en- 
larged the aperture of the stricture, which may be known by passing- 
a bougie through it, of the sarhe size as that by which the caustic 
was conveyed, the bougie used in the second operation, should be a 
size larger, than the one, used in the first; but it must not be too 
large to pass through the stricture. If the patient had no pain on 
the first application, the bit of kali purum may also be trivially lar- 
ger. At the end of seven days more, the armed bougie should be 
introduced a third time. At this, and all future applications, the 
bougie should be increased in size, in proportion as the aperture in 
the stricture becomes dilated. The quantity of caustic, however, 
is never to be increased in a ratio to the size of the bougie. In no 
cases whatever, does Mr. Whately apply more of the kali purum 
at a time, than a piece about the size of a common pin's head. 
Twelve bits of the largest size, which this gentleman ever Uses.) 
"Weigh one grain. 

When there are several strictures, the kali purum should be 
generally applied to only one at a time. 

An interval of seven days is what Mr. Whately generally allows 
to elapse between the application of the caustic. The rule, how- 
ever, may now and then be deviated from ; but the kali purum 
ought never to be re-applied, till the action of the last application 
has completely ceased. In a few instances, the interval may only 
be five days ; in some others, it may be eight, nine, or even a lon° 
ger space. 

In the above method of using the kali purum, Mr. Whately re- 
presents, that this substance is equally diffused over every part of 
the strictUred surface, and only abrades the membrane of the stric- 
ture, without producing a slough. The degree of this abrasion, he 
says, may be increased, or lessened, as circumstances dictate, by 
pa\ing attention to the quantity of the caustic.'* 

Mr. Charles Bell, another author to whom we owe much both 
for the variety and value of his publications, has lately presentect 
Us with some important observations on the subject of strictures" 
in his « Letters concerning the Diseases of the Urethra." 

The varieties of stricture enumerated by this author are con- 
siderably greater than those of former writers. He divides then* 
into simple (permanent) stricture, ulcerated stricture, stricture 
from inflamed lacunse, stricture near the orifice of the urethra, 
dilatable stricture, spasmodic stricture, stricture with stone in the- 
urethra, callous strictures, and narrowness of the urethra with, 
wasting of the spongy body. , Of the first, or simple stricture^ 
Mr. Bell observes, that it frequently has the appearance described 
by Mr. Hunter, as if a thread were tied round the urethra and a& 
if there were a membrane tucked and hanging across the canal, 
" In introducing the bougie or probe, we feel the point start over 
the stricture so as to convey to us precisely this notion." When 
this stricture, is newly formed and the inflammation continues, 
there is around the firm line of it, a thickened baseband if iheia* 

23 



178 OF OBSTRUCTIONS TN THE URETHRA r Cb. III. 

flammation occurs as a consequence, Mr. Bell observes, that not 
only the stricture will increase, but the passage is apt to be further 
choaked by a crust of coagulable lymph, which forms behind. 
This disease is ascertained by the use of the soft bougie and the 
introduction of the urethra sound,* (see plates J and is cured by 
the operation of the caustic. Mr. Bell approves throughout, of 
Mr. Home's practice in tnis variety 

As to ulcerated stricture, Mr. Bell observes, that he has met 
with it on dissection. ' k I have found (says he) a firm stricture, 
in the centre of which there was an excavation by ulceration, and 
we must conclude that either the stricture must have ulcerated, or 
the original uicer must have hardened, so as to condense the sur- 
rounding cellular substance, and produces a very firm cicatrix and 
consequent stricture." 

An ihllamed lacuna sometimes produces the symptoms and sen- 
sations of a stricture, but we muy often ascertain the nature of 
this case by examining with the finger on the outside. We feel a 
small hard body, like a seed or pea within, or rather attached to, 
the canal, and a bougie on being introduced, will be flattened or* 
one side. To remove this complaint, Mr. Bell prefers the alka- 
line caustic used by Mr. Whateiy. 

The stricture near the orifice of the urethra is generally of a 
grey or ash colour, and hard as cartilage. Mr. Bell prefers the 
frequent use of the bougie to the caustic in this variety, which 
latter produces great distress and no ultimate benefit. He has al- 
so used the knife, — by making two transverse incisions upon it. 

The consideration of stricture from stone in the urethra does 
not properiy belong to this place. For the removal of callosities, 
which Mr. Bell supposes to originate from high inflammation, he 
prefers the alkaline to the lunar caustic, as the latter does not kill 
the part to which it is applied, thus producing a slough, and laying 
the foundation for increased obstruction, but only subdues the sen- 
sibility of the part and facilitates the operation of dilatation by the 
bougie. A narrowness of the canal attended with wasting of the 
spongy body, may be removed by the occasional use of the bougie. 

Mr. Bell observes that stricture and inflammation in any part of 
the urethra are apt to produce inflammation and irritation near the 
neck of the bladder and for the removal of these, he advises the usu- 
al remedies, viz. leeches, fomentations, mild purges, and the use 
of the bougie or urethra sound On dissection, where persons have 
died, in consequence of stricture and an acute attack of inflamma- 
tion, Mr. Beil has found, the whole extent of the urethra inflamed, 
but chiefly that portion which lay between the stricture and the blad- 
der, and a firm coat of coagulabie lymph is generally depositee', on 
the inflamed surface of the urethra. Cavities were found on the 
side of the canal where it passes into the prostate and sometimes a 
minute crop of soft warts growing from the membrane of the ure- 

* Mr. Bell prefers the previous introduction of the Urethra Sound to that of 
the Bougie, as the former does not produce that general irritation along" the 
whole canal of the. urethra, which is caused in many cases by the latter. 



Sec. IV. FROM STRICTURES, &C. 179 

thra were found in the vicinity of a stricture. The bladder, if the 
'disease be of long* standing, is thickened in its coats ; and some- 
times much increased in size. An enlargement of the ureters and 
kidneys is a frequent occurrence. 

To the subjects of dilatable and spasmodic strictures, Mr. Bell 
has devoted separate letters. We proceed to an analysis of them. 

The author considers the dilatable stricture as a consequence of 
severe Gonorrhoea, in which the directions of the medical atten- 
dant have not been properly attended to, and although the discharge 
has sometimes disappeared, yet occasionally the symptoms return. 
A heat of urine often occurs, with a diminution of the stream and 
a frequent call for evacuation. Any irregularities with women or 
wine, cause an increase of the symptoms with a considerable dis- 
charge from the urethra On introducing the bougie, there is se- 
vere pain, and the urethra is unusually sensible, but if allowed to 
pass, a resistance and a grasping of the bougie as in common stric- 
ture will be experienced. The urethra sound may be passed with 
more ease, but there is considerable uneasiness when it touches the 
diseased part. The urethra in this complaint is less rigid and firm, 
but the dilatable stricture is not unfrequently combined with an 
unelastic and confirmed stricture. Mr. Beil observes that the dis- 
ease often continues for a length of time in this state, the symptoms 
neither increasing or diminishing in severity. The cause he consid- 
ers to be a diminution of the natural elasticity of the urethra, ori- 
ginating from the previous inflammation of Gonorrhoea, which 
prevents a due distention of the part when the push of urine is 
made or the bougie is introduced. In speaking of the method of 
cure, Mr. Beh opposes the use of the bougie and remarks that the 
pressure on the inflamed part by this instrument and the consequent 
stretching of the membrane, causes increased pain and soreness, 
but adds, however, that the peculiar irritability of its former mor- 
bid state is diminished. " The caustic is a milder and more effec- 
tual remedy." In using the kali liurum, as recommended by Mr. 
Wnateiy, he found much immediate benefit, such as a freer dis- 
charge of urine and less disorder in the functions of the parts, but 
soon observed that it made little impression on the stricture, only 
destroying the attendant irritability without removing the disease— 
By applying the lunar caustic in the same way that he had clone the 
kali purum, viz. by drilling a hole in one of the ball probes (see 
plates J and loading it with a small portion, he found that the irrita- 
bility which is frequently produced by it was avoided and a cure ef- 
fected. 

The subject of Spasmodic Stricture is introduced by an endeavour 
to prove that no such disease can exist. The cause assigned for 
this opinion is that the canal of the urethra, anterior to the muscles, 
is destitute of muscular power, and experiments on the living sub- 
ject ; dissections of the part of the urethra in the neighbourhood of 
the stricture, where no muscular fibres were discerned ; and the 
proposition that stricture is a callous part, incapabie of contraction 
an4 relaxation are adduced as the proofs. 



ISO ©P OBSTRUCTIONS IN THE URETHRA Cll. Ill, 

The true nature and cause of spasm attending strictures in the 
lirethra, Mr. Bell supposes to depend on the following changes for 
a healthy state of the urethra and bladder. He premises by observe 
iiis, that the sole origin of all strictures is inflammation, and of these, 
most commonly, the Gonorrhceal inflammation. The gleety dis*- 
charge which follows this disease, is not the effect of mere relaxa- 
tion, allowing too profuse a discharge, but the vestiges of infiam- 
inflation in a milder and more chronic form. If this state of the parts 
t>e permitted to continue, a firm stricture will in the end be formed 
and the degree and firmness of the contraction will depend on the 
length of time and the frequency of the occasional increase of the 
Irritation, pain and discharge. The spasm am 1 difficult flow of urine 
attending on ail the stages of stricture is attributed by Mr. Beli to 
an over action and irritability of the bladder, and the muscles con- 
tiguous to the bladder, prostate gland, and the urethra, antagonize 
lng with the muscular coat of the bladder, and thus producing the 
various states of contraction of the bladder and relaxation of the, 
vrethra, or the relaxation of the urethra and quiescence of the blad- 
der. The introduction of the bougie causes a distention of the mus- 
cles and a consequent contraction of the bladder, with a flow of 
urine. A mutual disorder of these different organs will therefore 
account for the above phenomena, 

Another and more frequent cause of spasm in the urethra and 
neck of the bladder, Mr. Bell states to bean increased sensibility. 
This accompanies inflammation and where the stricture is exqui- 
sitely sensible, there the functions of the muscles will be deranged. 
Contraction, spasm and obstruction, follow this disorder of the mus- 
cles surrounding the stricture, provided it be seated within five 
inches of the bladder. In the application of lunar caustic to the? 
spasmodic stricture, the sensibility will be deadened and the patient 
will feel relieved. But in many cases, after a few days the slough 
Is thrown off, and a spasm and irritability greater than before fakes 
place. To prevent the caustic from sloughing the parts, it was in- 
troduced at the end of a soft bougie, so that it could affect the stric- 
ture only in solution and not in sufficient strength to produce the 
former effect, whilst repeated introductions of the bougie, but for 
a space of time not exceeding two minutes, removed the disposi- 
tion to spasm. 

The following case by Mr. Samuel Cooper, author of several 
approved surgical works, is copied as an instance of the. conse- 
quences which may occur from the application of the lunar caus- 
tic. It is extracted from the Edinburgh Med. and Surg. Journal, 
for July 1S09, ami contains that gentleman's opinion on the sub- 
ject of armed bougies^ to the correctness of which we fully sub- 
scribe, 

V Most practitioners in surgery, who are in the habit of treating 
strictures on the plan recommended by Mr. Home, must have had 
repeated occasion to observe a troublesome degree of bleeding, 
after applying the caustic to the disease. Mr. Home, himself, has. 
related several such instances., and I hay© in my recollection a few 



Sec. IV. FROM STRICTURES, &C. 1 SI 

which have fallen under my own observation. The cases which have 
been published by the above gentleman, only interrupted the pro* 
stress of the treatment for a short time ; about a week afterwards, 
the use of the armed bougie was generally resumed, and a cure ul- 
timately accomplished. 

Of late, however, I have met with an example, in which the 
bleeding- was so profuse, and productive of such debility, that it 
would be the height of imprudence ever to subject this particular 
patient again to another haemorrhage of the same kind. 

A medical gentleman, from the West-Indies, consulted me, a- 
bout a fortnight ago, on account of a discharge from the urethra, 
and a fluctuating, circumscribed, prominent, and painful swelling 
in the perinaeum. As the feel of the tumor clearly indicated the 
presence of a fluid, I made an opening with a lancet, and gave 
vent to about a table-spoonful of purulent matter, apparently quite 
unmixed with urine. A linseed poultice, and a T bandage were 
applied. 

At the next visit, I learnt, that at the time of making water, a 
part of the urine was discharged from the wound in the perinaeum ; 
and, on attempting to introduce a flexible gum catheter into the 
bladder, an obstruction was discovered in the urethra, about six 
inches from the orifice in the glans penis. 

The following morning a trial was made to introduce a small -sized 
bougie, through the stricture, but this could not be done ; and, the 
day afterwards, it was determined to apply an armed bougie, which 
"was performed in the manner dictated by Mr. Home Some little 
degree >f bleeding ensued, and the pain was much less than the 
gentleman had apprehended. 

After waiting one or more days, the caustic was again passed 
down to the stricture, kept applied about a minute, and then with- 
drawn some little time to see whether the haemorrhage would stop 
of itself, and finding that it still continued in a very copious man- 
ner, I dipped a large towel in cold water, and put it over the 
penis and perinaeum. Some abatement in the bleeding now took 
place, and a clot of biood stopping up the mouth of the urethra, 
I was induced to hope the haemorrhage would soon cease alto* 
gether. 

In this expectation, however, I was greatly disappointed ; for, 
on my return home in the afternoon, I found a letter from one of" 
my patient's relations, desiring my instant attendance, as he had 
almost blecl to death. The note having been brought to my house 
when I was out, Mr Cline was sent for, who appeased, in a veiy 
material degree, the fears which had disturbed both the patient and 
his friends. When I entered the room, about four o'clock in the 
afternoon, I found several towels, all completely soaked in blood, 
a great part of the bedding wet through with the same, and a large 
bason, such as is used for washing one's hands, neaily full of coagu- 
Jated blood. Were I to guess the quantity iost, I should certainly 
not estimace it at less than five pints. The gentleman was so re- 
duced, that the. mere exertion of turning in bed would make him. 



182 OP OBSTRUCTIONS ITS THE URETHRA, &C. 61). HI. 

faint ; and the great loss of blood he had sustained, considered with 
Ms general appearance, made me seriously apprehensive of the 
consequences. 

The bleeding began about a quarter before eleven in the forenoon, 
and continued, more or less, till eight in the evening. 

The case seems to me worthy of being recorded, on account 
€f its exhibiting an example, in which the quantity of blood lost 
was unusually great, and in which the effects of the haemorrhage 
on the constitution were such, as to forbid exposing the patient 
again to the same accident j lest it should bring on fatal conse- 
quences. The gentleman's health has been already so much re- 
duced, that both Mr. Cline and Mr. Abernethy, who have been 
consulted, recommend no attempt to be made to remove the stric- 
ture, till the state of the constitution has been improved. 

Having always been an advocate for Mr. Home's plan of treat- 
ing strictures, no one can suspect me of publishing this case with 
a view of bringing the method into disrepute. I still give a general 
preference to the employment of armed bougies, because they 
seem to me most efficacious ; and the above case is the only one in 
which the fear of haemorrhage has ever induced me to abandon this 
mode of treatment." 

In the preceding observations, we have endeavoured to give a 
faithful account of the cases, and arguments adduced by the most 
distinguished of those writers, who in opposition to Mi.B ja- 
inin Bell, Howard and ©tlaers, prefer the application of bougies 
armed with caustic, to the use of common bougies. On a s/dbject 
where such diversity of opinion exists, and so much mutual iii-will 
has been produced, we hardly dare offer any thing more than a few 
observations on the various points under discussion, and we pre- 
sent these rather as suggestions to assist the inexperienced, than as 
matured remarks for tho^e who have seen and reflected on the dis- 
ease. We consider in the first place, the observations of Mr. 
Charles Bell and others on the anatomical structure of the urethra, 
as for the most part conclusive, proving that the canal of the ure- 
thra at its anterior part is destitute of muscular fibres ; and indeed 
most of his remarks on this subject and on the mutual influence of 
the bladder and urethra, are highly important. His assertion how- 
ever, that no disease like spasmodic stricture exists, whilst he al- 
lows that spasm is a common and indeed inseperable attendant on 
this species, is merely stating the difficulty in other words, and the 
surgeon has still to contend against this troublesome symptom. — 
The use of the common bougie ought in all cases to precede the 
application of the caustic, and as a general rule, it must be ob- 
served, that the latter is improper, where the former can be passed 
without much difficulty. Mr. Hunter himself allows the common 
bougie to be adequate to the cure, except where the permanent 
stricture is so complete as not to admit the point of one, and to 
this may be added the case of an inability to introduce a full siz- 
ed bougie after a persevering trial with those of inferior magni- 
tude. On the question of permanency of cure, Mr. Home in his 



Sec. T. OP DERANGED SENSATIONS, &C. 183 

"Work on strictures, mentions that in cures affected by caustic, there 
is often a return of this disease ; but as a general observation it is a 
more certain remedy than the common bougie, which is not 
unfrequently a palliative only. The decided superiority of lu- 
nar cuustic over kali purum, in removing the diseased part of the 
canal and affecting a certain cure, is so well settled by the concur- 
rent testimony of practitioners, that «\ve need not dilate on it.— 
As to the danger from hemorrhage, a sufficient answer is found 
in the fact that it may be induced as well by the simple as the arm- 
ed bougie. We conclude by again refering the reader to Mr. 
Home's work, in which he will find the subject better treated 
than in any other production of the present day. A deliberate and 
able statement of the advantages of the common bougie is con- 
tained in the Appendix to Mr. Howard's work on the Venerea! 
Disease. 

Ed, 



SECT. V. 

Of deranged Sensations in the Bladder, Urethra and 
contiguous Parts. 

ON the running and other leading symptoms of 
Gonorrhoea becoming moderate, all the others usually 
abate, and the patient, for the most part, is perfectly 
well, soon after the discharge leaves him. 

This, however, is by no means universally the case, 
for it sometimes happens that a good deal of distress 
remains long after the discharge is completely remov- 
ed, and as the symptoms which take place in this state 
of the disease are of a nature which cannot be referred 
to any particular head, I have judged it proper to 
speak of them in a separate section. 

Without any fixed pain, a patient, who, from the 
discharge and other symptoms of Gonorrhoea leaving 
him, has cause to imagine that his cure is completed, 
will be suddenly seized with uneasiness over his loins ; 
painful feelings over all the region of the bladder, 
particularly about the neck of it ; sense of weariness 
on the kidneys which sometimes become much pain- 
ed ; a considerable degree of uneasiness over the whole 



J 84 OP DERANGED SENSATIONS Ch. lit. 

course of the urethra, particularly about the glans, 
and a painful sensations of rolling, and other unusual 
motions, in the testicles. 

In some cases these symptoms, which seem to be 
Confined to the organs of urine and generation, take 
place either in whole, or in part by themselves. At 
other times they are conjoined with affections of other 
parts, chiefly with those of the stomach and alimentary 
canal. In one case 'they were accompanied with regular 
attacks of cholic, which had all the appearance, from 
the violent degree of pain which occurred, of proceed- 
ing from inflammation, but which always subsided im- 
mediately on the symptoms being removed by which 
it seemed to be induced. In different instances I 
have known sickness and vomiting succeed to that 
painful uneasiness to which patients in this situation 
are sometimes liable in the kidneys. 

Distressful feelings frequently occur in the rectum 
which give cause to suspect, in some instances, that they 
proceed from piles, a*id in others from tumours form- 
ing in the end of the gut. A painful tenesmus often 
accompanies this set of symptoms. 

In some, almost every symptom occurs which usual- 
ly takes place in stone in the bladder. A dull, heavy 
pain is f^H at the neck of the bladder, which spreads 
along the urethra, and fixes upon the glans. The pa- 
tient is distressed with frequent desire to pass water, 
^nc\ in passing it, it often stops suddenly When coming 
off in a full stream. 

In a few cases symptoms of paralysis occur, both in 
the bladder and urethra. The patient at one time find- 
ing it difficult, or even impossible, to force the urine: 
out of the bladder, while at others, it runs off in drops, 
without his being able to retain if. 

These unequal states of the power of passing and 
retaining the urine will sometimes occur alternately, 
several times in the course of the same (lay ; while at 
times one of them will continue for several days togeth- 
er, and at last will disappear suddenly, after hrving re- 
sisted every remedy that had been employed for it, 



SeC. Y* Itf THE BLADDER, &C 185 

It will readily be supposed however, that all of these 
symptoms cannot probably occur at the same time in 
the same patient, but every practitioner must have met 
with all of them in different patients^ 

At the same time that they take place with som^ va- 
riety, they likewise occur in very different decrees* 
In some they are so slight as merely to excite some tri- 
fling degree of uneasiness, and so transient, that V ,s ^y 
come and go frequently in the course of the sane day ; 
while, in others, they are so fixed and permanent that 
the patient remains in a state of constant distress, and 
experiences such a degree of it as he is scarcely able 
to support* 

In women, the bladder, kidneys, and abdominal viV 
Cera, are equally liable to be affected as in men ; and 
they are also apt to be distressed with uneasiness about 
the neck of the womb, and bearing-down pains, stretch- 
ing to the thighs* 

Even in the most firm-minded people the symptoms 
I have described prove frequently very distressful ; but 
where the mind is weak, and the imagination easily af- 
fected, they arrive in some instances at the most alarm- 
ing height. In whatever degree they may appear, they* 
are attributed to the preceding disease having either 
been improperly treated or not completely cured ; and 
when tliis occurs in a mind prone to fears and anxiety, 
the distress which they are apt to excite, is in so ne 
instances so great, as can scarcely from such a cause 
be supposed to exist. Whether a course of mercury 
be advisable or not, the patient is never satisfied till 
this medicine be prescribed ; for he is always afraid 
that his constitution will be ruined if mercury be 
omitted. If this proves successful, or if he gets well 
when under it, he remains completely satisfied; but 
when tins does not happen, as is the case in most in- 
stances, he then believes that he is incurable, and that hi& 
situation is desperate. Every variety of nostrum is 
now had recourse to ; by the effect of these, and still 
more by the agony of mind under which he labours, 
his constitution at last begins to suffer* he gradually 



186 OF DERANGED SENSATIONS Ch. III. 

becomes weaker and emaciated ; and if his life is pro- 
longed, it is almost always a scene of anxious inquie- 
ti.de and distress. 

The cause of all or any of these symptoms it is of- 
ten impossible to explain. Were they to happen.chief- 
ly wl ere the previous inflammation has run high, or 
where tie patient, when under cure, had been partic- 
ularly apt to indulge in venery, excess of wine, or 
bodily fatigue, one or other of these causes would 
lend to account for them. But this is by no means the 
case. They are met with as frequently where the dis- 
ease has been of a mild nature, and where it was cur- 
ed in an easy manner, as where the symptoms have 
been severe and obstinate. Where this takes place 
we are apt to suppose that they are mostly,, if not en- 
tirely, of an imaginary nature, and to treat them ac- 
cordingly. This, to a certain decree, may often be 
proper, as it may fortify the mind of the patient 
against those ill grounded fears to which he might oth- 
erwise be exposed; but we are not to suppose that 
symptoms of this kind are always ideal, merely from 
our not being able to account for them, or from the 
previous Gonorrhoea having been of such a mild na- 
ture as we may imagine ought not to have produced 
them. J met with instances of this, where the previous 
disease was exceedingly mild, and where no obvious 
affection of the parts was perceptible, and yet the vio- 
lence of the distress in such a degree as kept the pa- 
tients in a state of constant misery. 

Many of the symptoms enumerated above are sucli 
as are produced by tumours about the neck of the blad- 
der, particularly by affections of the prostate gland, 
and by a contracted state of the bladder itself. In 
such cases, the cause of the disease is at once render- 
ed obvious by examination with the finger in ano ; but 
at present we are supposing that no organic affection 
can be discovered either inwardly or outwardly, an 
occurrence by no means uncommon, and in which I 
therefore conclude that the symptoms proceed from a 
deranged state of the nerves, produced by the previous 



SeC. V. IN THE BLADDER, &C. 187 

affection of the urethra. I have accordingly arrang- 
ed all of them under one general head of Deranged 
Sensations, nor is there cause, from the nature of the 
remedies found to prove most successful in removing 
them, to treat of them separately, nearly the same 
general treatment being found to answer in all of them. 

Before proceeding to enumerate the remedies for af- 
fections of this kind, I may observe that although we 
cannot in any case say positively what will accomplish 
a cure, I can with certainty say what will not answer, 
I have already remarked, thai patients, in this situa- 
tion, are apt to suspect that their symptoms proceed 
fro n the previous disease having been improperly 
treated? This leads them to imagine that a latent poi- 
son is still lurking in the constitution, and mercury be- 
ing the only certain antidote for the venereal poison, 
they always ins st upon this being prescribed. Some 
practitioners still entertaining the opinion of Gonor- 
rhoea and Lues Venerea proceeding from the same in- 
fection, consider it necessary to prescribe mercury for 
all the consequences of each of them, while others are 
readily prevailed upon, by the solicitation of their pa- 
tients, to permit what they may suppose it would not 
be in their power to prevent. But from all the expe- 
rience which I have had of it, I am clearly of opinion 
tuat no advantage is ever derived from it, while, in a 
great proportion of cases, it evidently does harm. By 
relaxing the constitution, it renders it much more irri- 
table than it was before, and thus tends to aggravate 
all such symptoms as those we are now considering. 

Trie remedies upon which we chiefly depend are, 
blood-letting, opiates, warm bathing, blisters, cicuta, hy- 
oscyamus, electricity, Jesuit's bark, and cold bathing. 

When the constitution is already much reduced and 
debilitated, blood-letting must necessarily be inadmissi- 
ble ; but whenever plethora takes place, nothing proves 
more useful than blood-letting, both general and local, 
particularly the discharge of blood from the perineum, 
and parts contiguous to the anus, by the application of 
leeches. In such circumstances it removes or lessens 
irritability with more certainty than any other remedy. 



18S OP DERANGED SENSATIONS Ch. III. 

Even where there has been cause to suspect a tenden- 
cy to para'ysis in the bladder and contiguous parts, 
leeches applied as near as possible to the seat of the 
disease have proved serviceable ; nor need we ever 
hesitate in advising them where the patient is not much 
emaciated. But the remedy which, in all affections 
of this kind, proves most universally useful is opium. 
Il not only soolhes and allays the present distress, but 
when, by a well judged, timeous application of il, we 
can, for a week or two together, prevent the accession 
of pain, we in this manner often accomplish a cure. 
Ii answers the purpose whether it be given by the 
mouth or in cl)sters, but it proves always most eff'ec- 
tuabwhen given in sufficient doses by the anus. 

The exier nal application of laudanum, and of arm- 
dvne balsam, in some cases affords relief, particularly 
when conjoined with aether. In those deranged sensa- 
tions which sometimes occur in the perineum and 
about the neck of the bladder, immediate relief is of- 
ten obtained by rubbing the parts affected with a mix- 
tine of warm laudanum and aether ; and I have known 
the suppression of urine, which occurs from this cause, 
relieved in the same manner. 

When opiates fail in procuring relief, or when they 
disagree with the patient, the semicupium sometimes 
succeeds. Warm fomentations applied to the perin- 
eum, and over the loins, often prove useful ; and the 
steams of warm vinegar, conveyed with attention to 
the parts affected, have likewise been used with ad- 
vantage. The best article we can employ in such ca- 
ses for fomentations is a strong decoction of the heads 
of poppies. 

Blisters, in all such affections, are perhaps the most 
effectual of all our external applications. It is chief- 
ly, however, where the urethra seems to be the seat 
of the disease that they prove useful, and where the 
neck of the bladder is affected with such a degree of 
weakness as prevents the urine from being retained by 
it. In the former, blisters act with most advantage 
"when applied to the perineum, and in the latter they 
should be, applied to the loins. The most distressful 



SeC. T. IN THE "BLADDER, &C. 189 

sensations produced by this cause, and which for ma- 
nv years have obstinately resisted every other remedy, 
have, in some instances, been removed by the appli- 
cation of a blister to the perineum. In some cases one 
proves sufficient ; but in others they require to be re- 
peated once and again before all the symptoms disap- 
pear. 

Upon the same principle with blisters, exciting a 
return of the running after it has stopped, or after it 
has been diminished in quantity, has at times been 
productive of some benefit. This may be done by fo- 
menting the penis and perineum with warm water, the 
application of warm poultices to the perineum, and by 
a cautious use of bougies. The practice was probably- 
suggested by symptoms of this kind having in some 
instances been removed by the, patient getting a fresh 
attack of Gonorrhoea from a new infection, different 
cases of which f have met with. 

In all such instances, where the inflammation recent- 
ly induced is considerable, the previous symptoms are 
either much diminished in violence, or entirely remov- 
ed. This would lead to the practice of exciting an in- 
flamed state of the parts in a considerable degree, and 
which bouaies will never fail to do, if covered with 
oil of turpentine, with a small quantity of common 
resin melted in it; but as it is obvious that much harm 
would ensue from this practice being carried any great 
lei gth, it ought to be managed in every instance with 
the greatest delicacy and attention. 

It may be proper to remark, that it proves chiefly 
useful where the disease is confined to the urethra ; al- 
though, in some cases, it has succeeded even where 
the bladder and kidneys have been affected. 

Where the urine in such cases passes off involunta- 
rily, blisters, we have said, answer with most certain- 
ty when applied to the loins. This probably proceeds, 
from the disease in these instances arising, for the most 
part, from an affection of the bladder itself; but where 
it proceeds, as it may sometimes do, from a tendency 
to paralysis in the urethra and muscles connected with 



190 OF DERANGED SENSATIONS Ch. IIT. 

it, blisters will prove most useful when applied to the 
perineum. 

Where the urine passes off in this manner, balsam of 
copaiba, and other astringent balsams, are usually given. 
The)' are supposed to act chiefly by restoring the tone 
of such parts as appear to be relaxed and weakened, 
and which it is imagined they must do, from their hav- 
ing a peculiar tendency to pass off by the organs of 
mine. In like manner the internal use of cantharides 
is prescribed, from an idea of this symptom depend- 
ing, in every instance, on a loss of tone in the parts af- 
fected, and from our knowing, that in most cases, can- 
tharides proves a powerful stimulus both to the kid- 
ne) s and bladder. 

All of these balsams, as well as the common turpen- 
tines, which are not essentially different, may in all 
such cases be used with safety. In some instances they 
may perhaps prove useful, and I do not imagine they 
will ever do harm. This, however, cannot be sail of 
the internal use of cantharides. In large quantities 
they act as a poison : and even where managed with 
caution, the principle of the practice seems, in such 
cases as we are now speaking of, to be doubtful ; for 
as there is cause to suppose that the disease proceeds 
more frequently from too much irritability about the 
neck of the bladder and urethra, than from any defi- 
ciency of tone, there is reason to fear, that by increas- 
ing the sensibility of the parts affected, they would in 
many instances be more apt to do harm than good. It 
is therefore proper, previous to the internal exhibition 
of cantharides, to determine with accuracy whether 
the disease proceeds from real weakness or morbid ir- 
ritability. In the one case they may sometimes prove 
useful ; in the other they will be apt to add to the vio- 
lence of the disease. 

Cicuta has been frequently prescribed here ; and 
when given to such extent as to act as an anodyne, it 
may sometimes prove useful. Upon the same principle, 
hyoscyamus may with propriety be prescribed ; but 
we have no reason to suppose that either of these arti- 
cles act in any manner in curing the disease. As no 



Sec. V. IN THE BLADDER, &C. 191 

organic affection appears to take place here, they can- 
not act by dissolving hard or enlarged parts. Any ad- 
vantage derived from them will therefore be nearly in 
proportion to the anodv ne effects which occur from 
them ; and in this view, they may prove useful when 
opiates disagree with the stomach, as in such circum- 
stances it is of consequence to have it in our power to 
employ remedies of a similar operation. 

Electricity has now and then given a temporary re- 
lief to symptoms of this kind. It should be exhibited 
in the form of sparks drawn from the parts chiefly 
affected, particularly from the perineum, and parts 
most contiguous to the ne< k of the bladder. 

It is proper however, to remark, that the same ob- 
servations are applicable in advising electricity that 
were made upon the internal exhibition of cantharides. 
Both of these remedies, as well as the application of 
blisters to the loins, have been chiefly prescribed, where 
in affections of this nature, the urine passes off invol- 
untarily, and they are advised upon the idea of this 
symptom proceeding from paralysis of the neck of the 
bladder. But as there is much cause to imagine that 
the frequent discharge of urine, which patients in this 
situation are sometimes distressed with, proceeds more 
from irritability in the neck of the bladder than from 
real weakness, there is reason to think that electricity, 
by increasing the sensibility of the part affected, and 
which, in many instances, it evidently does, will rath- 
er tend to aggravate the complaint. 

Blisters, whether applied to the loins or perineum., 
may prove useful, not merely by the discharge which 
they excite, but by the irritation which they produce 
upon the skin. There is nothing more certain than 
our being often able to remove pain and irritability 
from one part by exciting it in others. Of this we have 
frequent proofs in the application of blisters and other 
stimulants, in deep-seated pain in the side, where the 
distress is otten removed as soon as the skin becomes 
warm and uneasy, and long before any vesications are 
produced. Sinapisms applied to the feet, have, in 
some instances, removed head-ache when every other 



192 OF DERANGED SENSATIONS Cb. IM. 

remedy has failed. In like manner blisters seem to op- 
erate when applied to the perineum, for the removal 
of those sensations to which patients in this situation: 
are someti es liable. But electricity, as well as the 
internal use of cantharidcs, by tending to irritate the 
very parts in which the disease is seated, seem often to 
increase the violence of the symptom they were meant 
to rem* ve. 

By a due perseverance in the use of one or other of 
these remedies we commonly succeed in lessening of 
even in removing the violence of the distress; but as 
the symptoms are apt to recur, even after the patient 
considers himself as well, it becomes an object of much 
importance to obviate this. For this purpose, nothing 
proves so effectual as Peruvian bark and cold bathing. 
A free exhibition of the bark should therefore be pre- 
scribed, as soon as the pain and other symptoms have 
begun to diminish, and sea-bathing should be advised 
whenever it can be obtained. When this cannot be 
procured, cold water should be applied locally, both 
to the perineum and loins. Some advantage is derived 
from the parts being bathed with it, but it proves more 
effectual when forcibly dashed upon them. 

An involuntary discharge of urine, which we have 
already had occasion to speak of, proves always trou- 
blesome; but the distress which it excites, is trifling 
when compared with what arises from the patient not 
being able to expel it. Even without any inflamma- 
tion, and where no cause of obstruction can be dis- 
covered in the urethra, a patient will sometimes find it 
impossible to pass a single drop. This, no doubt, oc- 
curs frequently from other causes; but every now and 
then we meet with it as an evident consequence of ir- 
ritability in the parts chiefly affected in this disease. 

All the remedies we have already advised will be 
equally applicable in tiie treatment of this symptom* 
as for the removal of any of the others. Opiates* 
however, and warm bathing, prove chiefly useful ; but 
wl en relief is not soon obtained, it becomes necessary 
to draw the water off with a catheter'; and, as much 
harm is apt to ensue horn this being long delayed, it 



Sec. V* iN THE BLADDER, &X. 393 

ought to be advised as soon as the bladder appears to 
be sensibly distended. 

In some cases the introduction of a bougie will prove 
effectual ; and as this gives less pain and irritation than 
the passing of a catheter, it ought in the first instance, 
always to be preferred. One of the largest tSiat will 
easily pass should be made use of; and, after allowing 
it to remain in the bladder for a few minutes, the pa- 
tient should be desired to pass his water instantly on 
the bougie being withdrawn. This ought not to be 
done wilh much force and pressure, otherwise the neck 
of the bladder and urethra are apt to contract instant- 
ly on the bougie being taken out ; while the whole will 
pass completely off if it can be made to flow easily at 
first, along with the bougie. 

When this our intention in employing bougies is 
frustrated, we are under the necessity of employing 
the catheter; and, as it is of much importance, in all 
such cases, to prevent irritation as far as it can possibly 
be done, catheters of resina elastica should be employ- 
ed, instead of the common instrument of silver. It not 
only passes more easily, but when any difficulty occurs 
in getting it into the bladder, it may, in some instan- 
ces, be proper to allow it to remain for a day or two 
together, which can never, with any propriety, be done 
with catheters of silver. 

The practice of leaving catheters in the bladder is 
spoken of by some with much ease, and they advise it 
whenever any permanent stoppage occurs to the urine ; 
but I have in different instances seen so much mischief 
produced by it, that it is a measure I never advise but 
where much pain and difficulty occurs in the introduc- 
tion of a catheter. In most instances, more pain is ex- 
perienced from the instrument being allowed to remain 
in the bladder, than ever occurs from its being fre- 
quently passed. Besides the irritation, which even the 
smoothest and softest instrument of this kind excites, 
they are apt to prove hurtful by incrustations of calcu- 
lous matter forming upon them, in consequence of de- 
positions from the urine. There are few people whose 
urine is so free of this kind of matter as to prevent a 

25 



194 OF SWELLINGS OF THE TESTICLES. Ch. III. 

catheter, inserted into the bladder, from becoming 
rough with it in a very short space of time. This prac- 
tice, therefore, ought never to be adopted but where the 
greatest difficulty is experienced in introducing the ca- 
theter. 



SECT. VI. 

Of Swellings of the Testicles. 

A Swelling of one of the Testis is a very frequent oc- 
currence in Gonorrhoea. From the resemblance which 
it bears to a hernia, and from its being supposed to 
proceed from the running or humour in Gonorrhoea 
falling down upon the testes, it is usually termed a 
Hernia Humoral is. 

Tn some instances both testicles swell. They sel- 
dom, however, swell both at once; but the swelling, 
on leaving one testicle, is very apt to go to the other ; 
and when both have in this manner been affected, they 
sometimes swell alternately for a considerable time to- 
gether. J have known this happen for the space of a 
year and upwards, where the patient, during the whole 
period, was never completely free of the disease. 

In long continued affections of this kind, the pain 
becomes inconsiderable , but the first attack of the 
disease is always accompanied with severe pain. The 
first warning which the patient receives of it is a very 
painful sensation in one of the testis, striking along 
the spermatic cord, near to the middle of his back. On 
examining the testes he finds it swelled, and so tender 
that he can scarcely bear it to be touched. He feels 
himself hot, and a general uneasiness prevails over his 
whole body, particularly over his thighs and abdomen. 
Neither can lie move without increasing the violence 
o f e v e r y s v m p t o m . 

At first the swelling is confined to the epididymis ; 
the hack part of the testicle feels hard and enlarged ; 
but in a very short space of time, often in the couise of 



Sec. VI. OP SWELLINGS OF THE TESTICLES. 195 

an hour, the whole body of the testicle becomes swell- 
ed. In this state of the disease a difference is still per- 
ceptible between the testis itself and the epididymis. 
The latter is hard, and somewhat unequally so ; being, 
for the most part, hardest and most prominent at the 
bottom, whereas, a soft uniform sv\elling prevails over 
al! the anterior part of the testicle. 

In the progress of the disease, indeed, even the tes- 
tis itself becomes hard, and if the means employed for 
preventing it do not prove successful, the swelling of 
the epididymis and testis together come to form a tu- 
mour of very considerable magnitude, accompanied 
with a red inflammatory affection of the scrotum. 

In tliis state of the disease, the pain is often intense, 
accompanied with a very distressful sensation of the 
testis moving or rolling about. The skin is dry and 
parched, the tongue foul, thirst prevails, and the pulse 
is full, and quick. In short every symptom takes place 
vvhich usually attends a high degree of local inflamma- 
tion. 

There is no period of Gonorrhoea in which this af- 
fection of the testis does not occasionally supervene. 
It occurs in all stages of the disease ; even towards the 
end of it, when both the patient and surgeon are apt to 
consider the cure as nearly complete : and in some we 
find it take place where no cause can be assigned for 
it, where neither the degree of the previous inflamma- 
tion, nor the mode of life of the patient, were such as 
could in any satisfactory manner account for it. 

ft is proper, however to remark, that swellings of the 
testis which take place in this manner, seem, for the 
most part, to be of a very different nature from those 
which occur during the virulent state of the disease, 
and while the inflammation in the urethra is considera- 
ble. The latter appear to be altogether inflammatory. 
The disease proceeds more slowly to its height or 
acme. It remains more permanently at the size to 
which it arrives, and it disappears more slowly than 
the others, vvhich come to their utmost height? i^ some 
instances in an hour or two from the first approach of 
the swelling, and again disappear with equal rapidity. 
These I conceive to be partly inflammatory, and that 



196 OF SWELT INGS OF THE TESTICLES. Ch. Ill, 

in part (hey proceed from that kind of sympathy which 
evidently subsists between the penis and testis, and 
which renders the one very apt to sutler from any dis- 
ease with which the other may be affected. That 
sympathy has much influence in the production of this 
variety of the disease, is obvious from the swelling be- 
ing apt to leave one testis, as we have already observed, 
and to fix, perhaps instantly, upon the other. This 
does not occur so frequently as the alternate affection 
of the eyes, from one of them only being at first 
allectcd, but every practitioner must have met with in- 
stances of it. 

As it is observed that the running in Gonorrhoea is 
apt to stop on the first appearance of a swelled testicle, 
1 is gave rise to the idea of the affection of the testis 
proceeding from the matter falling down upon it, in 
consequence of being thus obstructed in its passage 
through the urethra. It is now well known, however, 
that no communication subsists between the urethra 
and testis, by which matter can pass from the one to 
the other ; nor does the appearance which a swelled 
testicle affords, give reason to imagine that it proceeds 
fiom this cause. Instead of being soft and compressi- 
ble, which it necessarily would be were it produced by 
matter, it becomes daily harder, till it arrives at a cer- 
tain magnitude, when if gradually becomes softer again, 
hut without any fluctuation of matter being perceived 
in it. 

There is reason to imagine, that in most instances 
the testis become affected by the inflammation spread- 
ing from the urethra along the vasa deferentia. This 
has been doubted by some, but without any good rea- 
son being assigned for it, nor has any other mode of 
accounting for it been suggested. VVe see that by the 
vasa deferentia a direct communication takes place be- 
tween the urethra and the testis, and the first appear- 
ance of a swelled testicle commences in the epididymis, 
formed as it were by the termination of this very line 
of communication. In a great proportion of cases loo, 
the patient is sensible of a pain stretching from the 
swelled testicle along the groin, which we know to be 
fjie direct course of the vas deferens, 



SeC. VI. OF SWELLINGS OF THE TESTICLES. 197 

A variety of other causes might be mentioned, 
which tend to excite inflammation in the testis in a sim- 
ilar manner with Gonorrhoea : among these are, the- 
irritation produced by a stone in the neck of the blad- 
der ; by the irritation on the introduction of a cathe- 
ter or bougie ; and the inflammation which takes place 
in these parts after the operation of lithotomy. A 
swelling of one or both testes is not an unfrequent oc- 
currence from all of these, particularly from the latter, 
and from the use of bougies, especially when they are 
not properly introduced ; and we see no manner in 
which it can be so readily produced as by the irritation 
excited about the neck of the bladder, carried along 
the vasa deferentia. 

The consequences of swelling of the testis, which we 
have most to dread are, a hardened state of the part3, 
chiefly of the epididymis, which, even when one, but 
more certainly when both testis are swelled, is apt to 
be followed by impotency ; and a morbid irritability, 
which is sometimes so great as to prevent the patient 
for a considerable time from using any kind of exer- 
cise, and from following the ordinary occupations of 
life, without hazarding a return of the swelling of the 
testis. Suppuration in the body of the testis, from the 
inflammation induced by Gonorrhoea, is hardly an ob- 
ject of regard, for it does not take place in one of five 
hundred cases. 

But the two circumstances I have mentioned of a 
permanent hardness in the epididymis, and that distress- 
ful irritable state of the testis itself, which are apt to 
succeed to this disease, are objects of the first impor- 
tance, and require an immediate application of every 
remedy that can probably tend to prevent them. 
Scarcely any occurrence can prove more troublesome 
or inconvenient than swellings of the testis ; and an 
enlarged state of the epididymis, when it takes place in 
any considerable degree, has, in many instances, as I 
have already observed, the effect of inducing impoten- 
cy. To a certain degree, a swelling of the epididymis 
often continues for a great length of time ; in some in- 
stances, during the life of the patient, without any bad 



198 OF SWELLINGS OF THE TESTICLES. Ch. III. 

consequence faking place, particularly when one testi- 
cle only is affected. But I have known so many instan- 
ces of the contrary, and of such distressful effects ensu- 
ing from it, as makes me with confidence say, that no- 
thing should be omitted that can or might probably 
tend to prevent or remove it. 

As we find that all the symptoms of this disease, as 
well as the consequences which ensue from it, are usu- 
ally severe in proportion to the degree of inflammation 
which takes place, it ought to be our view, in every 
instance, to prevent' lb is from arriving at any great 
height* This is most effectually done by blood-let- 
ting ; a proper use of laxatives; opiates; the applica- 
tion of anodynes and astringents to the parts affected; 
preserving t lie body in a proper posture, and suspend- 
ing the testicle. 

Of all these remedies blood-letting is the most effect- 
ual and certain, particularly local bloodletting by the 
application of leeches. Jn plethoric patients, or where 
the swelling arrives at any considerable bulk, blood 
should be taken from the arm in such quantities as the 
strength will permit, while, at the same time, a num- 
ber of leeches should be applied over the testis. But 
in weakly people, particularly where none of the symp- 
toms are violent, the abstraction of blood by means of 
leeches alone will commonly prove sufficient. 

The first application of leeches to a swelled testicle 
excites a good deal of uneasiness. They increase the 
irritability of the parts, and an increase of the tumour 
seems to be induced by them ; but the discharge has 
seldom continued for the space of an hour or two till 
the pain abates, the tension, which before was consid- 
erable, becomes much less distressful, and the swelling 
even appears to lessen in bulk, and in the course of 
tie following day the patient can allow the parts which 
he could not previously bear to be touched, to be hand- 
led with freedom. 

For the most part one application of leeches, if a 
proper number has been used, proves sufficient ; but 
when any of the symptoms still continue severe, par- 
ticularly when the swelling does not diminish, when 



rSeC. VI. OP SWELLINGS OF THE TESTICLES. 199 

the pain does not lessen, and when the febrile symp- 
toms do not abate, it becomes in some cases necessary 
to repeat the application of leeches once and again. I 
think it here proper to remark, that we should never 
hesitate in this situation to take blood with freedom. 
A constitution must be delicate indeed that will be in- 
jured even with repeated applications of leeches; and 
I am satisfied that very important advantages ma} he 
derived in all cases of swelled testes from a timeous 
and proper use of them. 

Abstraction of blood by means of leeches is not on- 
ly useful in shortening tie duration of the inflamma- 
tory symptoms, but, in consequence of this, it proves 
serviceable in preventing two very distressful conse- 
quences, which swelling of the testes is very apt to in- 
duce, viz. that swelled, indurated state of the epididy- 
mis which I have mentioned, and the most frequent 
variety of hydrocele, formed by serum collected in 
the tunica vaginalis. We have already had occasion 
to remark, that a permanent swelling of the epididymis 
is a very frequent effect of an inflamed testicle, and I 
have met with several well-marked instances of hydro- 
cele proceeding from the same cause. That blood- 
letting in any way, whether general or local, will at 
all times prevent the accession of these symptoms, I 
will not pretend to assert; but, from the result of 
much observation, I am convinced that it answers this 
purpose with more certainty than any other remedy 
that has vet been employed. 

In many situations leeches cannot be procured; 
when this happens to be the case, nearly the same ad- 
vantage may be derived from small punctures being 
made on different parts of the swelling. The punc- 
tures should be made with the point of a lancet, and if 
the scrotum be previously immersed in warm water, 
nearly the same quantity of blood will be obtained 
from them as from the same number of leeches. 

As swelling of the testicle in Gonorrhoea seems in 
every instance to proceed from the irritation excited 
in the urethra, it is an object of the first importance to 
remove every cause that can in any degree tend to irri- 



200 OF SWELLINGS OF THE TESTICLES. Ch. HI. 

tale either the urethra or contiguous parts. Hence, 
where costiveness prevails, gentle laxatives prove par- 
ticularly useful. I have known different instances of 
hardened feces collected in the rectum inducing swel- 
lings of the testes; and nothing tends more certainly 
than this to keep up the disease, by whatever cause it 
may at first have been induced. But although cos- 
tiveness is to be guarded against, we are, for a similar 
reason, to shun the opposite extreme. Strong purga- 
tives alwa\s excite much irritation in the rectum, and 
are therefore to be caiefully avoided in Gonorrhoea. 
It must consist with the knowledge of every practi- 
tioner that they universally do harm. Where the bow- 
els are moderately easy, no medicines for this purpose 
can be required, but when they are not in this situa- 
tion, castor oil, flowers of sulphur, cream of tartar, or 
any other gentle laxative, should be employed. Even 
these should be given in small doses, repeated at pro- 
per interval?, rattier than that any risk should be in- 
curred of exciting irritation in the rectum by their be- 
ing exhibited in larger quantities. 

With a view to lessen and remove the irritation and 
pain in tlietu nour with as much certainty and expedi- 
tion as possible, opiates should be prescribed imme- 
diately on the pain becoming severe. When they can 
be avoided till one or more easy stools have been pro- 
cured, they prove most useful ; but when much irrita- 
tion prevails, no regard should be paid to this. As 
the sickness and general uneasiness which sometimes 
occur from a swelled testis are evidently the effect of 
irritation, nothing proves so effectual m removing these 
symptoms as adequate doses of opiates ; and at the 
same time that they remove this distress of the system 
by lessening the pain, they also tend to carry off the 
swelling of the testicle. From an idea that opiates 
tend to increase the heat and other symptoms of fever, 
many practitioners are afraid of using them wherever 
fever takes place in any considerable degree : but mu< h 
experience of their influence enables me to say, that 
they may be employed with much sa fetv and advan- 
tage in every stage of swelled testis where the degree 
of pain is considerable 



SeC. VI* OF SWELLINGS OF THE TESTICLES. 201 

This is so remarkably the case, that I have known 
instances of the hernia humoralis, as it is termed, being 
cured by opiates alone, which did not yield to the 
usual remedies.* In whatever manner Gonorrhoea may 
act in exciting swelling of the testis, the tumour, when 
once produced, excites so much irritation, that, till 
this be lessened, the swelling for the most part contin- 
ues obstinate. Next to blood-letting, opiates prove 
the most effectual remedy for this purpose. 

While the internal exhibition of opiates thus proves 
useful, advantage is often derived from applying them 
to the swelling itself. This may be either by the ap- 
plication of soft pledgiis, soaked in laudanum, or ano- 
dyne balsam, or by poultices made with a strong de- 
coction of poppy heads and crumb of bread. 

All the saturnine applications prove useful here. 
When Goulard's extract, as it is termed, is employed, 
or what is nearly the same, the acetum lythargyri, 
it ought to be in greater quantities than are used in 
other parts of the body ; for the testes being protected 
by different coverings, remedies of this kind, when of 
the ordinary strength, do not readily affect them. 
When saccharum saturni is employed, as it will not 
dissolve in sufficient quantity in water, if vinegar be 
not added, and as vinegar proves an useful application, 
even by itself, these two remedies ought always to be 
combined. 

The steams of warm vinegar act as an useful discu- 
tient here. In applying them, the testes should be 
properly suspended over a vessel in which boiling vin- 
egar is contained ; or the swelling may be fomented 
from time to time with flannel immersed in warm vin- 
egar, and so strongly wrung, that nothing but steam 
remains upon it. Vinegar, in every form, acts with 
much advantage in this disease, and this gives a plea- 
sant variety in the way of applying it. 

Whatever remedy is employed, the body should be 
kept as much as possible in a horizontal posture, at the 
same time that the scrotum should be properly sus- 
pended. We find by experience that no remedy will 
prove effectual while the patient continues to walk 

26 



202 OF SWELLINGS OF THE TESTICLES. Cll. TIT, 

about ; while, in many instances, a horizontal posture 
of itself, will have a considerable effect in removing 
the disease. In suspending the scrotum, care should 
be taken to do it in such a manner that the testicle be 
completely supported without being compressed. Pres- 
sure, even in a slight degree, always does harm, and 
ought to be avoided. 

We have already had occasion to observe, that in 
Gonorrhoea a stoppage of the discharge often takes 
place on the first approach of a swelled testis. This 
leads to the idea of some advantage being to be deriv- 
ed from our exciting a return of the running; and 
there is not a doubt of this proving in some instances 
useful. The discharge from the urethra not only les- 
sens the inflammation in the part from whence it pro- 
ceeds, but it has also an influence on the tumour of 
the testis. As it is now universally admitted that a re- 
turn of the running does not act by drawing matter di- 
rectly from the testis, some have suspected that it never 
can prove useful. But why may not a discharge exci- 
ted in the urethra act in a similar manner in removing 
an inflammation of the testis, that we know from daily 
experience happens with setons and other issues in the 
treatment of inflammatory affections of other parts? 
The fact indeed, is, that a plentiful return of the dis- 
charge very commonly relieves all the symptoms of 
this disease. 

For the purpose of exciting a return of the runnings 
bougies prove most effectual; but in affections of the 
testis they require to be managed with a delicacy not 
usually observed in this branch of practice : foi v if 
more pain or irritation be produced than is necessary 
for the purpose, instead of acting as a remedy, they 
necessarily aggravate every symptom. In common 
practice, I think it better to trust to the frequent ap- 
plication of warm emollients; such as the immersion 
of the penis in warm milk, or in decoction of althea, 
or lintseed ; applying warm poultices over the penis, 
and injecting warm oil or milk into the urethra. 

From the instantaneous manner in which swellings 
©f the testes sometimes succeed to a stoppage of the 



SeC. VI. OF SWELLINGS OF THE TESTICLES. 203 

discharge in Gonorrhoea, and from their appearing, we 
are told in some instances, even to precede this stop- 
page of the running, some have doubted whether they 
are to be considered as the cause or effect.* That the 
testes may first inflame and the running afterward stop, 
cannot be doubted. But although this may happen in 
a few instances, the very reverse is what we common- 
ly meet with, insomuch that patients who have once 
been affected with swellings of the testes, are very apt 
to experience a return of the disease in every Gonor- 
rhoea to which they may in future be liable, solely 
from the running being carried off in the usual way. 
I know several, who, for this reason, dare not use 
even the mildest astringent injection; otherwise they 
are sure to have a swelling of the testis induced : while, 
in others, it swells at the termination of the running, 
whether injections have been used or not. In the 
course of my observation, therefore, do cause for 
doubt has occurred upon this subject. 

By a proper application of the different remedies 
we have mentioned, swellings of the testes are for the 
most part soon relieved, and at last carried off entire- 
ly excepting that permanent hardness to which the 
epididymis, as we have seen, is particularly liable. 
But although this is the common event of the disease, 
yet instances are not wanting, most frequently indeed 
from the patient's misconduct, of the whole body of 
the testis remaining swelled, and obstinately resisting 
all those remedies which usually prove effectual. If, 
in this situation, some application be not made, by 
which the size of the tumour is soon diminished, and 
if it be allowed to remain stationary for any length of 
time, it is very apt to continue much enlarged, and 
sometimes of a schirrous hardness during the life of 
the patient. I may also remark, that it is this state of 
the disease which is most apt to terminate in hydro- 
cele ; or effusion of serum into the tunica vaginalis tes- 
tis, with which it is sometimes attended. 

In this situation mercury is commonly employed^ 

* Vide John Hunter, on the Venereal Disease. 



264 OF SWELLINGS OF THE TESTICLES. Cb. Ill, 

and, in some instances when given slowly, as an alter- 
ative, I have seen it prove useful ; but it is. doubtful 
whether a complete course of mercury should ever be 
advised or not, for when it does not carry off the swel- 
ling, which seldom happens, it is apt to increase it, and 
to induce pain and irritation in the tumour when none 
existed in it before. Whenever mercury, therefore, is 
advised, it ought to be in such quantities as cannot tend 
to quicken the circulation or excite fever. A decoc- 
tion of mezereon has in some instances been given with 
advantage along with mercury.* 

It is in this state of a swelled testis, where the tu- 
mour does not yield, but remains nearly of the same 
size after the inflammation by which it was induced is 
gone, that emetics are most likely to prove useful. 
They have been used, I know 7 , in all periods of the 
disease ; but it is chiefly in the situation we are now 
speaking of that I have seen them act with advantage. 
A smart emetic, carried a proper length, will some- 
times, in the space of an hour or two, lessen the bulk 
of a tumour which had for several weeks obstinately 
resisted every other remedy. In some cases one eme- 
tic proves sufficient, while, in others, it requires to be 
repeated once and again. Mercurials were formerly 
used for this purpose. This was done from the dis- 
ease being considered as a symptom of Lues Venerea,, 
and for which mercury was known to be the only anti- 
dote. But we now know that tumours of the testes, 
which take place merely from Gonorrhoea, never par- 
take of the Venereal Virus; and accordingly emetics, 
of whatever nature they may be, prove equally use- 
ful here with mercurials, provided the shock which 
they give to the system is equally considerable. 

I have sometimes, in this state of a swelled testicle, 
applied a blister with advantage. It might not perhaps 
be altogether safe to apply blisters while the scrotum 
continues much inflamed ; hut when the external inflam- 
mation and tension subside, they may be advised with 
safety ; and, in different instances, I have known them 

f Vide Appendix, No. 45'. 



Sect. VL OF SWELLINGS OF THE TESTICLES. 205 

accomplish a reduction of the swelling of the testis, 
where other remedies had for some time been employ- 
ed without any effect. 

A due perseverance in the use of some or all of these 
remedies will seldom fail where a swelling of the testi- 
cle is altogether inflammatory; but where it proceeds 
in a great measure from irritability, as we judge to be 
the case where the swelling comes and disappears sud- 
denly, or where it comes and goes from one testicle to 
another, other remedies are, in this situation, found to 
prove more effectual. 

Even in this variety of the disease, blisters some- 
times prove qseful; and I have known the irritation 
removed, and the swelling carried off in the course of 
a short time by opiates; but these afford only a tem- 
porary relief, and do not prevent the disease from re- 
turning on the slightest application of any of the exci- 
ting causes which usually tend to induce it. 

The remedies which here prove most effectual are 
cold bathing, and a plentiful use of bark. Sea bathing, 
when the season permits, should in the first place, be 
advised, but when this cannot be obtained, cold water 
may be used at home, with a proportion of common 
salt dissolved in it. It answers a good purpose wheth- 
er the whole body be immersed in it, or merely the 
scrotum bathed in it, but for the most part, I have 
thought that it proves most effectual when applied to 
the scrotum only. As bark and cold bathing act upon 
the same principle, that is, by giving tone and vigour 
to parts which we suppose to have been deprived of 
them, they may either be used together, or exhibited 
separately, as the patient may incline. 

The testes, we find, are apt to decay. One of them 
will begin to lessen in bulk, and, in a gradual manner, 
disappear entirely, or leave only a thin membranous 
substance in its place. Generally the other remains 
sound ; but I have known instances of both becoming 
affected at the same time, and others where the one 
remained entire as long as any part of that which was 
first affected was perceptible, but where it also began 
to decay as soon as the other was entirely destroyed. 



206 OF SWELLINGS OF THE TESTICLES, Ch. Ill, 

This affection occurs at all periods of life, but most 
frequently after the 40th year. In many instances, no 
cause whatever can be assigned for it ; but I have ob- 
served that it is most frequent in people of delicate con- 
stitutions, where the muscles are soft and relaxed, and 
the complexion wan and sallow. I have also found that 
those in whom it occurs, have, in almost every in- 
stance, been in early life particularly addicted to 
Onanism. 

In a few cases it has appeared as an evident conse- 
quence of a swelled testicle. On the fulness produced 
by the disease being removed, the process of absorp- 
tion by which this was accomplished does not stop, but 
goes on till the whole testis is carried off. In some in- 
stances this takes place while the testicle continues to 
the last of its natural degree of firmness, or even while 
the hardness still prevails which occurred during the 
state of inflammation by which the swelling was at 
first induced : but, in others, before this wasting pro- 
cess commences, the testicle becomes soft and pulpy, 
or even dissolves into a fluid. It is seldom attended 
with pain, the patient being, in many instances, igno- 
rant of his lo-s till one, or perhaps both, testes are 
nearly consumed. 

Hitherto no certain remedy has been discovered for 
putting a slop to this complaint. Mercury, hemlock, 
and electricity have been tried, but with no advantage 
The cold bath has for a time seemed to prove useful, 
but the disease returned again, and both testes were 
dissolved. In one case, Where one of the testes was 
consumed before the patient perceived it, and where 
the other was evidently affected, I applied a blister 
over it. This wasting process stopped, and never re- 
curred again. The patient, is about 36 years of age. 
His inclination and powers of propagation, he says, 
are still as strong as they were before, and he has late- 
ly had a child. 

Among the causes of hernia humoralis, the authors partiality 
has prevented him from naming injections. The early use of these 
in the inflammatory stage cf Gonorrhoea, by checking the discharge 
from the urethra, has often given rise to this peculiarly distressing 



Sec. VI. OF SWELLINGS OF THE TESTICLES. 207 

complaint. It is generally observed that when the swelling has been 
removed, the running is less in quantity than it was previously. 

A disease termed Fungus of the Testis, has been mentioned by 
some writers and particularly by Mr. Lawrence, the Demonstrator 
of Anatomy at St. Bartholomew's Hospital, as an occasional. conse- 
quence of the hernia humoralis from Gonorrhoea. Injuries of va- 
rious kinds are also named among the causes and in some cases if 
has originated spontaneously. The following symptoms are stated 
by the writer named above. " It is preceded by a painful swelling 
of the testis, which is peculiarly hard to the touch. After a certain 
length of time, the scrotum, growing gradually thinner, ulcerates, 
but the opening which is thus formed, instead of discharging mat- 
ter, gives issue to a firm and generally insensible fungus. The sur- 
rounding integuments and cellular substance are thickened and in- 
durated by the complaint, so that there appears to be a considera- 
ble mass of disease. The pain abates and the swelling subsides 
considerably, when the scrotum has given way. In this state the 
disorder appears very indolent, but if the fungus be destroyed, the 
integuments come together and a cicatrix ensues, which is insepa- 
rably connected to the testicle." Mr. Lawrence considers that the 
glandular substance of the testis as the original seat of the com- 
plaint and that the confinement of this swollen substance by the 
dense and unyielding tunica albuginea is the cause of the peculiar 
hardness of the tumour and the pain attendant on it. The absorp- 
tion of the coats of the testis and the scrotum remove the tension? 
and give ease to the patient. It is conjectured by Mr. L. that the 
disease might be cured spontaneously, but from its being so indo- 
lent, this would not be effected until after a long time, The modes 
which he proposes for removing the fungus, are either, the knife, 
or if the nature of its attachment permit, the ligature, or it may be. 
freely treated with escharotic applications. Castration, he cos- 
siders as altogether improper and unnecessary. Nine cases are re- 
lated by Mr. L., in some of which, red precipitate or lunar caustic 
(nitras argenti) were used with success and in others the knife. 
The application of the ligature in one case caused severe pain, but 
since that time it has, in other instances effected a cure. 

It must be observed, that Mr. Lawrence considers the removal 
of the protuberance to a level with the scrotum, by means of the 
knife as the shortest and most effectual mode of treatment. (Edin- 
burgh Med, and Surg. Journal, vol. 4, 257.) Ed, 



208 OF SWELLINGS OF Ch. Ill, 

SECT. VII. 

Of Swellings of the Spermatic Cord. 

THE Spermatic Cord is liable to swellings of dif- 
ferent kinds, but it is such only as proceed from Gon- 
orrhoea that we are here to notice. 

It sometimes happens that inflammation of the tes- 
ticle spreads to the cord, and excites pain and tume- 
faction along the whole course of it. At other times 
the cord inflames without any previous affection of the 
testis; it becomes tense, hard, and painful. The swel- 
ling, for the most part, is at first confined to the vas 
deferens, but at last the other parts of the cord suf- 
fer also. 

I have met with some in which one or two tumified 
parts were perceived in the course of the cord, while 
the rest of it remained sound ; but, in general, the 
cord is equally affected, from the testis along its whole 
course up the groin. 

On the first approach of this disease, as it is always 
accompanied with pain and tension, with some inabil- 
ity to walk, the patient is induced to treat it with at- 
tention ; but, where the swelling is not soon Carried off, 
the pain will sometimes abate, or even vanish altogeth- 
er; and in this state, where the tumour is not consid- 
erable, the patient is led to suppose that no harm can 
arise from it; by this neglect the swelling is often ren- 
dered so firm and hard that no remedies we can em- 
ploy have any influence in removing it. In some ca^ 
ses I have met with a hard ring, affecting the cord only 
at a particular spot, where the diseased part was near- 
ly as firm as bone, while the rest of it was in a soft 
natural state. 

While the tumour is confined to one part of the cord 
I have seldom known it increase to any alarming de- 
gree, but whether it be circumscribed, or extended 
over the whole length of the cord, no time should be 
lost in the application of remedies for removing it. In- 



See. VII. THE SPERMATIC CORD. 209» 

dependent of other reasons, if the vas deferens be 
chiefly affected or even only compressed in its course, 
the testicle will be rendered as certainly useless as if it 
were extirpated : even this, in some instances, where 
one side only was affected, has appeared to render the 
patient impotent, and it will never fail to do so where 
the disease affects both sides. 

The remedies that prove most effectual here are 
blood-letting, blisters, and such others as are usually 
employed with advantage in swellings of the testis. 
These we need not particularly enumerate, as they were 
fully treated of in the last section • but it may be proper 
to remark that blood-letting proves chiefly useful on 
the first approach of the disease, and in this state, 
when properly applied, that it seldom fails in removing 
it. It may in some cases, be necessary to take blood 
from the arm, but the local discharge of it by leeches 
applied to the part affected, is at all times to be morer 
depended on. 

Where the discharge of blood, however, does not 
soon lessen the size and hardness of the tumour, we 
need not afterwards expect any advantage from it. 
In this case I have repeatedly known blisters prove 
useful when applied along the course of the cord ; but 
neither are they to be depended on if some effect be 
not soon perceived to result from them. 

In partial affections of the cord a small blister appli- 
ed to the diseased part, and the part kept open with, 
ointment of cantharides, has tended to reduce the 
swelling. 

Mercury is commonly employed here, and where 
the disease does not soon yield to blood-letting and 
blisters it is perhaps the only remedy from which any 
advantage is to be expected; but I have commonly 
found, where the swelling has been carried entirely off 
by mercury, that there has been much cause to ima- 
gine that the patient at the same time laboured under 
Lues Venerea. In some cases, the disease has subsist- 
ed in an evident form of pox in othvr parts of the 
body, while, in others, there was only grounds for 

27 



210 OF SWELLINGS OF THE Ch. Ill, 

suspicion. In all of these the mercury seemed to 
operate with more certainty when a decoction of me- 
zereon and sarsaparilla was conjoined with it. 

Mercurial frictions prove more useful here than any 
other mode of giving the remedy, and the application 
of mercurial plasters to the swelled parts acts with 
more advantage in swellings of this kind than in any 
other in which I have employed them. 



SECT. VIII. 

Of Swellings of the Lymphatic Vessels of the Penis. 

WE know, from the history of the Lymphatics, that 
they serve to inhale, and to carry into the general 
course of the circulation, not merely from the surface 
of the body, but from every other part of it, fluids 
applied to their open extremities. In this manner they 
remove from some parts what might prove hurtful if 
allowed to remain, and they carry into the constitu- 
tion from others what is obviously meant for the nour- 
ishment and support of it. But while this is their 
chief purpose, we also know that they carry into the 
system what often tends to destroy it. They seem to 
have no power of rejecting what proves hurtful, hence 
they imbibe poisons, and the most inoffensive articles, 
with equal readiness. All our contagious diseases are 
probably produced through the medium of the lym- 
phatics, and we can prove by experiment that this is 
the case with many of them ; particularly with the 
plague, the small-pox, and Lues Venerea. So readily 
is the matter of these diseases absorbed by the lym- 
phatics, that it can never with safety be applied to any 
part of the body ; for so quickly does absorption, in 
some instances take place, that we have frequent proofs 
of infection being carried into the constitution, even 
after much pains has been taken to wash away the 
matter by which it was produced, in the space of a 



SeC. VIII. LYMPHATIC VESSELS OF THE PENIS. 211 

minute or two after being applied to the surface of the 
body. 

For the most part we find that the lymphatics them- 
selves do not immediately suffer by the absorption even 
of the most noxious matter. They will convey the 
poison of a viper and other serpents into the course of 
the circulation, by which the animal will be killed in the 
space of an hour, while no vestige of its effects appears 
in the lymphatic vessels themselves. In like manner* 
the matter of Lues Venerea passes into the constitu- 
tion from the penis without any swelling or other mark 
of disease being perceived in the lymphatics through 
which it was conveyed. 

This, we must allow, however, is not universally 
the case. Instances sometimes happen of the matter 
of Lues Venerea passing through lymphatics that are 
hard and swelled, but we know from daily observation 
that it is not a frequent occurrence. We find, in- 
deed, that the lymphatic vessels in every part of the 
body are apt to swell and inflame on causes capable of 
exciting irritation being applied to them. Thus we 
often observe the lymphatics of the arm swell, become 
hard and painful from a prick in one of the fingers with 
a pin or a thorn, or even from a nail being cut too far 
in the flesh ; and in Gonorrhoea it is by no means un- 
common to find a hard lymphatic passing along the 
back of the penis, to the groin, arising in some instan- 
ces from the prepuce and in others from the urethra. 
But although this, as we have observed, occurs also 
in some cases of Chancre, we meet with at least twen- 
ty instances of the contrary, for one in which this af- 
fection of the lymphatics takes place. I think, too, 
that I have observed, where the lymphatics proceeding 
from Chancres have inflamed, particularly where the 
inflammation has been considerable, that the constitu- 
tion has not been so apt to suffer as where this did not 
happen. From all which, I would conclude, that in- 
flammation of the lymphatics, when in a high degree, 
instead of indicating an increased power of absorbing 
what is applied to them, as many have imagined, tends 



212 OF SWELLINGS OF TKE Ch. III. 

in a great measure to lessen, and, perhaps to destroy 
it. Till the fact is farther ascertained, which experi- 
ence and observation alone can do, it would be impro- 
per to place any dependence upon this in the treat- 
ment of Chancres. In all cases of Chancre, whether 
the lymphatics inflame or not, it would be imprudent 
to omit whatever might tend to render the constitution 
safe; but finding that much inflammation seems not 
only to lessen the power of absorption in the lympha- 
tics, but that they inflame from causes in which we 
know that no infection exists, as often happens from a 
prick or a cut with a clean instrument, we would from 
this alone be led to think that this affection of these 
vessels which occurs in Gonorrhoea, proceeds more 
from irritation than from any other cause. This idea, 
however, is farther confirmed by the proofs we have 
already adduced of Gonorrhoea being a local disorder, 
as well as by our daily observation of the rise and pro- 
gress of these swellings which occur in this disease. 
They commence with all the usual symptoms of in- 
flammation. A hard string, or cord, is perceived 
along the back of the penis. It is painful to the touch, 
and the teguments above it sometimes acquire an ery- 
sipelatous redness. The whole penis becomes stiff 
and uneasy, and this renders erections particularly 
painful. 

In a great proportion of cases the inflammation sub- 
sides quickly and easily, the stiffness and pain gradu- 
ally abate and the hardness of the lymphatic disap- 
pears entirely: but where the inflammation has either 
been severe from the first, or not properly treated, it 
proceeds in some cases to suppuration, forming one 
or more small abscesses in the course of the affected 
part. The sores, however, which ensue from these, 
heal readily, when the constitution is otherwise heal- 
thy, forming a very manifest difference between Gon- 
orrhoea and Lues Venerea. Similar affections of the 
lymphatics, which occur in the latter, require, for 
fhe most part, a course of mercury to remove them. 
I say for the most part only, from having met with 



SeC. VIII. LYMPHATIC VESSELS OF THE PENIS. 213 

more than one instance, of the sores which occur in 
Lues Venerea from this cause, healing without the use 
of mercury ; and which has induced me to think, that 
even in this disease, the lymphatics may swell and in- 
flame, merely from the acrimony of the matter, and 
that this inflammation may have some tendency, as I 
have observed above, to prevent the matter from pas- 
sing into the constitution. 

Where swellings of this kind in Gonorrhoea are con- 
fined to the lymphatic vessels, I have commonly found 
that cold poultices, prepared with crumbs of breads 
and acetum lythargyri, or saccharum saturni, prove 
more effectual than any other application. They re- 
move the swelling and hardness, and lessen the pain 
with more certainty, than warm emollient poultices. 
But where the inflammation spreads over the penis, as 
it sometimes does, it becomes necessary, not only to 
discharge blood from the arm, but to apply leeches 
over the pained parts. This, with a low diet, and con- 
fining the patient to a horizontal posture, very seldom 
fails in removing the disease. But it sometimes hap- 
pens, either from the neighbouring parts becoming se- 
verely inflamed, or from the diseased lymphatic burst- 
ing, that effusions occur in the contiguous cellular sub- 
stance, and small abscesses forming, they at last dis- 
charge their contents, and produce such sores as I have 
already had occasion to mention. 

The treatment of these should be the same as that 
of sores proceeding from any other cause in which the 
constitution is not affected. When their edges are 
hard and inflamed, emollient poultices will prove use- 
ful. For the removal of sloughs and foulness, red 
precipitate, or even caustic, may be necessary ; and 
for cicatrising them, nothing answers better than un- 
guentum e calce zinci, or ceratum e lapide calamin- 
are.* 

In two different instances of hardened lymphatics 
c in Gonorrhoea, besides the firm cord on the back of 

* Vide Appendix, No, xlvii. xlviil 



214 OF SWELLINGS OF THE €h. III„ 

the penis, a thin, flat, hard tumour, proceeding from 
this cord, spread round the whole substance of the pe- 
nis, for the breadth of a quarter of an inch. One of 
them was contiguous to, and immediately behind the 
glans. The other was near to the pubes. This last 
passed round the urethra, which it grasped so firmly, 
as to give cause to suspect, that at last it might prove 
a total obstruction to the urine. A course of mercury 
was tried in each of them, without any advantage. A 
small piece of mercurial plaster was then applied over 
the swelling, and this, with a gentle purgative of sea- 
water every second or third morning, was all that was 
advised. The swelling in each of them became con- 
siderably less, but never disappeared entirely. It did 
not, however, give any disturbance afterwards. 



SECT. IX. 

Of Swellings of the Glands in the Groin, 

THE swelling and inflammation of the lymphatics, 
described in the last section, frequently proceeds no 
farther than the root of the penis. At other times it 
goes the length of the groin, and affects one or more 
of the contiguous glands, which become hard, swelled, 
and inflamed, putting on many of the appearances of 
the venereal bubo. 

At other times these glands swell and inflame, where 
no affection of the contiguous lymphatics is percepti- 
ble. But although in such cases, no apparent inflam- 
mation occurs in these vessels, there is, however, much 
cause to imagine, that in a certain degree it always 
takes place. There is not, at least, any other obvious 
route by which the inflammation can be conveyed from 
the urethra to the glands in the groin. 

In some cases these swellings become large, and, 
notwithstanding our endeavours to prevent it, suppura- 
tion at last takes place : but, for the most part, if they 



SeC. IX. GLANDS IN THE GROIN. 21 5 

be not neglected af first, they may be very easily dis- 
cussed. In most instances, this may be accomplished 
by the use of saturnine poultices alone ; but where the 
pain and inflammation are severe, blood-letting, both 
general and local, becomes necessary. Laxatives al- 
ways prove useful, and a cooling, low regimen can sel- 
dom be dispensed with. 

The most perplexing part of the surgeon's practice 
here is, to determine the real nature of the tumour; 
to ascertain whether it proceeds merely from inflam- 
mation, or from the absorption of venereal matter. If 
from the last, mercury alone will prove effectual ; while 
no practitioner would consider mercury as necessary, 
for the removal of a swelling altogether inflammatory, 
Neither would it, in this case, answer any good pur- 
pose. It would not lessen the size of the swelling ' 
nay, by the fever which it sometimes excites, it might 
even tend to increase it, and disappointment to the 
practitioner, and much distress to the patient, might 
be the consequence. 

The circumstances upon which we chiefly form our 
judgment here, are these: if no chancre or excoriation 
has been perceived, either upon the glans or prepuce, 
and if the inflammation in Gonorrhoea has been con- 
siderable, there will be cause to imagine that the tu- 
mour is not venereal. When treating of chancre and 
venereal bubo, we shall enter more fully into the con- 
sideration of this ; but at present, I may observe, that 
buboes do not commonlv occur, without chancres go- 
ing before them. I know, indeed, from various cases 
which have fallen under my management, that, contra- 
ry to the general opinion, real venereal buboes some- 
times form without any previous chancre, or any ex- 
ternal affection ; but as it does not happen once in a 
hundred instances, we are sufficiently warranted in 
considering the absence of chancre, as a reason for 
supposing that swellings of this kind are not venereal. 

In such swellings as occur from Gonorrhoea, much 
pain and tension prevail, not merely in the diseased 
glands, but over all the groin ; and a general sympa- 



216 OF SWELLINGS, &C, €1). II? 

thetic uneasiness spreads over the thighs, and undef 
part of the abdomen. Even the testes and abdominal 
viscera sometimes suffer, whereas, in the venereal bu- 
bo, it is commonly one gland only that is affected, and 
the contiguous pads seldom become uneasy till the 
disease is far advanced; not, indeed, till the tumour 
has acquired such a size, as to excite pain solely by 
distention. The swelled gland, it is true, is painful 
from the first, and the pain becomes gradually more 
severe as the tumour increases; but the pain is chiefly 
confined to one part, and seldom spreads farther till the 
teguments are much stretched by the subsequent for- 
mation of matter. And, lastly, when glands swelled 
from this cause burst, the sores which ensue have a 
very different appearance from those produced by real 
venereal buboes. Their edges, instead of being hard 
and retorted, have more the appearance of sores which 
occur from common abscesses, and they soon begin to 
heal, even when mercury is not employed, which the 
others, we may observe, seldom do. 

This circumstance of these sores healing, whether 
mercury be used or not, is the most decisive charac- 
teristic of their true nature, and when any doubts of 
this are entertained, either from the swelling having 
taken place without a previous chancre, or from any 
other cause, we ought to delay the exhibition of mer- 
cury till their tendency to heal, or to degenerate into 
a worse state, be ascertained. 

If they put on a healing appearance, and gradually 
become less, there will be much cause to hope that a 
complete cure will be obtained, whether mercury be 
used or not ; while, on the contrary, this remedy should 
be immediately advised when the sores become foul, 
and their edges hard ; and particularly when, instead 
of healing, they extend to a greater size. 

The progress of the swelling also affords a mark of 
discrimination. The venereal bubo proceeds more 
slowly to suppuration than the inflammatory swelling 
of which we now speak, which most frequently, in- 
deed, is easilv discussed, and seldom arrives therefore 






SeC. X. OF EXCORIATIONS OF THE GLANDS, &C. 217 

at the state of abscess ; but when tumours of this de- 
scription do suppurate, it commonly happens in the 
space of a few days. I have known matter complete- 
ly formed in them in three or four days from their first 
appearance; a circumstance which perhaps never hap- 
pens in glandular swellings produced by the matter of 
Lues Venerea. 



SECT. X. 
Of Excoriations of the Glands dnd Prepuce 

BY the acrimony of the matter in Gonorrhoea the 
Glans and Prepuce are sometimes excoriated. A slight 
degree of inflammation takes place at first, either par- 
tially, or over the whole parts; and this being succeed- 
ed by a discharge of matter, the skin at last becomes 
fretted, and on being examined with a glass, the mat- 
ter is perceived to flow from an infinite number of 
small points, on the smallest pressure being applied to 
them. 

But, for the most part, this affection of the prepuce 
and glans takes place without any discharge from the 
urethra. In the course of a few days after connexion 
with an infected woman, and without any symptom of 
Gonorrhoea, a sensation of heat is perceived over the 
whole prepuce and glans, which soon terminates in a 
discharge of matter very similar to what comes from 
the Urethra in Gonorrhoea. From this circumstance, 
the disease has been termed Gonorrhoea Spuria. The 
matter indeed, is so similar to that of Gonorrhoea, that 
it is usually sometime before the patient can be con- 
vinced of its not coming from the urethra. It not on- 
ly resembles the matter of Gonorrhoea in colour and 
consistence, but likewise in quantity. In some cases, 
it is surprisingly great, owing to the great extent of in- 
flamed surface, in the numerous plies and doublings of 
the skin forming the prepuce. 



218 OF EXCORIATIONS OF THE Ch. III. 

In slight, affections of this kind, the prepuce contin- 
ues to move upon the glans as it does in health ; but 
when the matter is either of itself particularly acrid, 
or allowed by want of attention to remain till it be- 
comes so, the skin forming the prepuce, becomes so 
much inflamed and swelled, that it cannot but with 
much difficulty be made to pass backward and for- 
ward. In some cases this becomes impossible. If this 
happens when the prepuce covers the glans and cannot 
be drawn back, a disease is thereby produced, which 
we teim phymosis ; and when the swelling takes place 
when the prepuce is retracted and cannot be pulled 
over the glans, the ofisease is termed paraphimosis. 
Of these affections we shall speak more particularly 
in the ensuing sections. 

By many, this discharge of matter from the prepuce 
and glans has been judged to be venereal ; that is, they 
have supposed it to be produced by the matter of Lues 
Venerea. They therefore conceived it to be always 
connected with an affection of the constitution, and 
have accordingly, in the method of cure, been chiefly 
directed by this opinion. 

This opinion, however, is evidently not well found- 
ed. From much observation, I am convinced, that this 
discharge is of a local naiure, and that it is no more 
capable of affecting the constitution than the matter of 
Gonorrhoea. I believe indeed that this is now very 
generally admitted ; and that it is those only who 
doubt of it, who, taking their information from books^ 
have not^paid that attention to the event of those affec- 
tions, which in forming a judgment of them is abso- 
lutely necessary. It will be universally found that the 
discharge may be more easily removed by remedies 
applied directly to the parts affected than by mercury, 
or any medicines, given internally. Indeed, no ad- 
vantage is derived from the internal exhibition of med- 
icines, while the disease seldom resists the application 
of an astringent wash: neither is the constitution ever 
affected with pox from excoriations proceeding merely 
from Gonorrhoea. 



Sec. X, GLANDS AND PREPUCE, 219 

It is true that buboes and symptoms of pox some- 
times occur where the prepuce and glans have been 
previously affected in this manner, Of this I have seen 
many instances : but in all of these it has happened, 
that on enquiry, the patients were found to have had 
connection with diseased women during the continu- 
ance of the excoriation ; and whatever may be the 
opinion of some individuals upon this point, I believe 
few will doubt of an ulcerated or excoriated surface 
being particularly favorable for promoting the absorp- 
tion of any matter that is applied to it; insomuch, that 
it is the universal remark of patients, that they never 
escape being poxed, if in such circumstances they have 
connection with women that are infected. 

It is worthy of remark, that a small, partial excori- 
ation is always at first of a suspicious nature, while 
from any observation I have been able to make, every 
general affection of this nature, where the excoriation 
extends over the whole prepuce and glans, terminates 
easily without producing any constitutional taint. The 
disease sometimes at first, indeed, occupies a small 
spot, and afterwards extends gradually over t'e con- 
tiguous parts, and where, by the event, we judge of 
its being of the most innocent nature from no disease 
of the constitution being produced by it. But I have 
uniformly found, where a small part only has remain- 
ed for some time raw and excoriated, without ex- 
tending to the surrounding parts, that symptoms of 
pox succeed to it with as much certainty as they ever 
do to chancres. I therefore believe, that all partial af- 
fections of this kind, which remain for more than a 
day or two circumscribed, are produced by the matter 
of Lues Venerea, and that they ought accordingly to 
be treated as symptoms of that disease. Besides the 
other differences which we have elsewhere enumerated 
between the matter of Lues Venerea and Gonorrhoea 
Virulenta, it would appear that in this they differ in 
the most obvious manner. The matter of Lues Ve- 
nerea, however diffusible it may be when received into 
the system, from which indeed it is never expelled but 



220 OF EXCORIATIONS OF THE Gil. Ill, 

with the assistance of mercury, is always slow in its 
progress while only locally applied either to the penis 
or any other part. Neither can it be applied, as we 
have already had occasion to remark, to the smallest 
point, without much risk of pox being produced by 
it : whereas, the matter of Gonorrhoea, whether it be 
applied to the urethra, to the glans, or prepuce, spreads 
quickly over all the contiguous parts; while it is ob- 
vious to daily observation, either that it is not absorb- 
ed, or if it be taken into the system, that no constitu- 
tional disease ensues from it. 

Excoriations of this kind not only resemble Gonor- 
rhoea, in being produced by the same matter, and in 
being entirely local, but in the method of cure. We 
have already had occasion to see, that the. discharge in 
Gonorrhoea cannot be certainly removed, but by the 
use of astringent injections. In like manner, bathing 
the parts affected in astringent solutions proves the most 
effectual practice here. Lime-water answers particu- 
larly well for this purpose : also solutions of saccharum 
saturni, and of white vitriol: immersing the parts in 
brandy, or in a strong infusion of red-rose leaves, will 
sometimes remove the discharge on the first application. 
It is proper, however, to remark, that the more fre- 
quently remedies of this kind are applied, the more 
effectual they prove. They should be used at least five 
or six times daily, and for the space of a few minutes 
at each application. 

Emollient ointments are. frequently employed in af- 
fections of this kind, but the very cause which renders 
astringents useful makes every application of this na- 
ture improper. They constantly increase the dis- 
charge, while no advantage of any kind accrues from 
them. 

Neither do we find that purgatives, or any of the 
cooling medicines usually prescribed here are of any 
real utility. When much inflammation takes place, 
ihey may, in some instances, prove useful, but in all 
mch cases blood-letting is more to be depended on ; 
particularly the application of leeches to the parts irn- 



Sec. X. GLANDS AND PREPUCE. 221 

mediately affected, which, in all local inflammatory 
complaints, is to be considered as the most effectual 
remedy. 

It has been objected to the application of leeches in 
excoriations of the penis, that the wounds from the 
bites of these animals are apt to degenerate into vene- 
real sores. This proceeded upon the idea of all such 
affections being produced by the matter of Lues Vene- 
rea; but now when we know that this is by no means 
the case, it is obvious that the opinion must be ill found- 
ed ; and from various and repeated trials of the reme- 
dy in question I can decidedly say that it is so. 

But admitting that a case should occur, in which it 
might be doubtful whether the excoriation and swel= 
ling was truly venereal or not, still I would not hesi- 
tate in advising the application of leeches : they would 
prove more effectual than any other remedy in carry- 
ing off the inflammatory symptoms, while their bites, 
if they should put on the appearance of venereal sores, 
would immediately render the nature of the disease 
certain, which otherwise might long have remained in 
doubt. 

In all sores and inflammatory affections of these 
parts, the posture of the body and position of the pe- 
nis are circumstances requiring particular attention. 
The patient should be kept as much as possible in a 
horizontal posture ; and the penis should be elevated 
so as to prevent the glans from hanging pendulous. It 
often happens indeed, where this is omitted that swel- 
lings remain obstinate for many weeks together, which 
otherwise might have been carried off in a few days 



222 OF EXCORIATIONS IN WOMEN, Ch. fill. 

SECT. XL 

Of Excoriations in the Parts of Generation of Women. 

THE parts of Generation in Women are liable to 
excoriations of a similar nature with those enumerated 
in the last section. In some cases they are confined to 
the clitoris, nymphae, and labia pudendi. In others 
they spread to the perineum, and even to the groins 
and thighs, where, from negligence, and want of at- 
tention to cleanliness, I have known deep and very 
extensive ulcers produced. 

Where the excoriations are confined within the parts 
of generation, the symptoms are nearly such as occur 
from Gonorrhoea in the usual form of the disease ; but 
where the inflammation and rawness spread to the 
thighs, a great deal of distress is experienced in walk- 
ing, and in every motion of the body. 

The method of cure is nearly the same in women as 
in men. Bathing the parts frequently with one or oth- 
er of the astringent applications mentioned in the last 
section, for the most part, proves effectual ; for the 
excoriated parts seldom lie so deep as to require the 
use of the syringe; but when the parts become evi- 
dently ulcerated, bathing alone is not sufficient. In 
this case the ulcers fall to be treated in the same man- 
ner with sores proceeding from any other cause. When 
they are foul and sloughy, an ointment strongly im- 
pregnated with mercur. precipit. rub. is perhaps the 
best application we can use; and for the purpose of 
healing them, nothing answers better than common 
eerate ? with a large proportion of lapis calammaris, or 
unguent urn e cake zinci, for which prescriptions are 
given in the Appendix. 

When sores of this description do not soon yield to 
these applications, and especially when they spread 
and become deeper while the patient is using them, 
there will be some cause to suspect that a venereal taint 
exists in the constitution: in which case a course of 



SeC. XII. OF THE PHYMOSIS, &C. 223 

mercury should immediately be advised, being the only 
remedy upon which, in such circumstances,, we can 
place any dependence* 



SECT. XII. 

Of the Phymosis and Paraphimosis. 

IN section tenth we found it necessary to give a de- 
finition of these two diseases. Inflammation of the 
preputium always excites some degree of thickness and 
contraction. When the contraction occurs w-hile the 
prepuce covers the glans, and in such a degree as to 
prevent it from being pulled back, the disease thus 
produced, is termed phymosis. We say that paraphy- 
inosis takes place when the prepuce contracts behind 
the glans, and cannot be drawn over it. 

One of the most frequent causes of phymosis is chan- 
cres on the preputium. The thickening of the skin in- 
duced by chancres, and the inflammation with which 
they are apt to be attended, is often productive of phy- 
mosis ; but it also occurs from otlier causes. What- 
ever excites much inflammation of the penis will in- 
duce it. Hence it readily occurs in every case of Gon- 
orrhoea attended with any unusual degree of inflam- 
mation, particularly in the variety of the disease,, 
where the glans and prepuce are inflamed and excoria- 
ted. But although these excoriations often terminate 
in phymosis, it is certain that they are more frequent- 
ly productive of paraphymosis. The patient, in clear- 
ing away the matter necessarily draws back the prepu- 
tium, and when the parts are previously much inflam- 
ed and thickened, they are apt to contract so suddenly 
when in this state of retraction, that they cannot again 
be drawn over the glans. 

In the treatment of phymosis, we are often success 
ful by a proper application of emollients. No effect 
will result from them when the stricture has been of 



224 OP THE PHYMOS1S Ch. III. 

long duration ; but, unless the inflammation is unusu- 
ally severe, they will often answer if duly persevered 
from the first. Immersing the penis, from time to 
time, in warm milk, or in a decoction of althea root, 
or of lintseed, is perhaps the most effectual method 
of applying remedies of this kind ; and when much 
matter is produced between the prepuce and glans, ei- 
ther by chancres or inflammation, these liquids should 
be injected from time to time with a syringe. But 
with a view to lessen the discharge, after washing out 
any matter that may be formed, a weak saturnine so- 
lution should be injected three or four times a day, 
This, with a low diet, abstinence from exercise, and 
suspending the penis, will, for the most part, prove 
successful; but when the parts are much inflamed, it 
becomes necessary to take blood in quantities propor- 
tioned to the symptoms, not merely from the arm, but 
from the penis itself, by the application of leeches, 
which may always be done with safety where the dis- 
ease is local, as we have shown to be the case where 
it proceeds from excoriation or from Gonorrhoea : but 
when it occurs from chancres, as venereal sores are apt 
to ensue from the bites of leeches, it is better to omit 
them. 

While any considerable 4 degree of stricture remains, 
It is always improper to force the prepuce back. This, 
however, is often done, but it very commonly termi= 
nates in paraphymosis ; for when the parts are much 
contracted it is almost impossible to get the prepuce 
again brought over the glans, if it has once been for- 
ted completely behind it. It is better, therefore, to 
wait till the stricture is entirely removed, before any 
attempt is made for this purpose. Besides the risk of 
inducing paraphymosis, the irritation which it gives, 
tends always to render the stricture more obstinate. 
When the inflammation is altogether gone^ it may be 
proper, after immersing the penis in any of the emol- 
lients abovementioned, and rubbing it gently over with 
warm oil, to endeavour, from time to time, to stretch 
it toils usual extent; but even at this period of the. 



Sec. Xtt. AXD PARAPHYMOSIS. 225 

disease the prepuce ought never to be pushed back 
with such force as can excite any kind of uneasiness. 

In the treatment of phymosis it is proper to remark* 
that, in a great proportion of cases the stricture can 
never be altogether removed. In slight degrees of it 
we commonly succeed by the means I have mentioned* 
but whenever it is severe the parts remain under some 
degree of contraction, for the most part, during the 
life of the patient. We have it indeed in our power to 
remove even the most inveterate stricture that occurs* 
by laying the prepuce open, either by a partial inci- 
sion, or cutting it from one end to the other, accord- 
ing to the extent of the disease, but this is a remedy 
of too severe a nature for the removal of phymosis* 
in the ordinary form of the disease. Where the pre- 
puce is so much contracted as to interrupt the passage 
of urine, or to impede coition, it no doubt becomes 
proper to lessen or remove the stricture, but it is most 
frequently for obtaining ready access to concealed 
chancres that we advise this measure of laying the pre- 
puce freely open. 

Even chancres are often cured while the prepuce re- 
mains contracted; but this is only the slighter kinds of 
them. Whenever they are either deep or very exten- 
sive, although with much care and attention they may 
in some instances be cured, yet we are much more cer- 
tain of effecting our purpose, and of doing it speedi- 
ly, by laying the sores completely open. I am clearly 
of opinion* however, that a patient should rathqr sub- 
mit to an ordinary or slight degree of phymosis, where 
there is no disease concealed by it, than incur the pain 
and distress which must always ensue from this opera- 
tion. Many have it from their birth, and are not sen- 
sible of any inconvenience arising from it. 

It happens, indeed, in some instances, even of this 
natural phymosis, if we may so term it, that we are 
under the necessity of removing the stricture by an 
incision. This is particularly the case where the exu- 
dation natural to these parts is in such quantities as to 
excite irritation, which it is always apt to do when it 

29 



226 op The Phymosis Ch. m. 

adheres to the prepuce and glans. By much pains in 
washing with a syringe, the parts may be kept so clean 
as to prevent them from suffering with this mucus; but 
in general we find it necessary either to lay the con- 
tracted prepuce open from one end to the other, or re- 
move a portion of it entirely, so as to perform the ope- 
ration of circumcision. 

It may be proper to observe, that although this ope- 
ration of removing a portion of the prepuce is in itself 
exceedingly simple and easy, and never fails to answer 
the purpose where the parts are perfectly sound, that 
it is very apt to disappoint us entirely when they are 
under any degree of inflammation or irritation. In 
this situation, although the parts in which the stricture 
is seated be completely removed, the remaining ex- 
tremity of the prepuce contracts almost immediately 
after the operation, so as to create nearly the same de- 
gree of inconveniency which it did before. By the in- 
troduction of dossils of lint, sponge tent, and such 
other articles, we may for a time prevent the contrac- 
tion from becoming considerable, but the irritation 
which these applications excite, at last oblige us to lay 
them aside, when the stricture soon takes place in a 
degree equal to what it was before the operation. 

I have taken the more particular notice of this, from' 
different cases having fallen under my management, in 
which, by endeavouring to remove a contraction of the 
prepuce by the operation of circumcision, we were 
completely disappointed. In three of these the ope- 
ration was done by others. In one I performed it my- 
self. But although every thing was done in all of them 
that might probably render them successful, yet they 
all failed, and after a considerable time spent in trying 
to dilate the newly-formed stricture, I was in two of 
these instances obliged to perform the operation for 
the phyroosis in the usual way, by making a longitu- 
dinal cut through all the remaining part of the prepu- 
tiuvn. In one the stricture was not so considerable as 
to render it necessary, and in the other, the patient 
would not submit to it, 



SeC. Xli. ANB PARAPHYMOSIi. SMf 

Were we io remove the prepuce entirely, by dis- 
secting it completely away from that part of the perns 
where it begins to be formed by an elongation or pro- 
duction of the skin, the operation might probably an- 
swer our expectation, but it would leave the glans al- 
together uncovered, which in those who have been ac- 
customed to have it protected by the prepuce, is apt to 
excite very disagreeable sensations. Neither can I 
determine with certainty whether it would, in every 
case, answer the purpose of giving complete relief or 
not. Where the parts are previously in a state of irri- 
tation, the remaining skin might contract behind the 
glans, so as to produce some degree of paraphymosis; 
at least, in one of the four cases to which I allude, a 
very considerable portion of the prepuce was removed, 
and yet the remainder contracted in such a manner as 
to form a stricture which gave much distress. 

Different methods have been proposed for perform- 
ing the operation of a phymosis. For these the wri- 
ters on chirurgical operations must be consulted, but 
the easiest, and perl saps the simplest of any, is that 
which I have described in the system of surgery,* in 
which the incision is made by passing a sharp pointed 
bistoury along a directory between the prepuce and 
glans, and having pushed the point of the bistoury 
through the prepuce near to where it begins to form, 
the cut is completed by drawing the instrument for- 
ward ; in which manner it is done, not only more neat- 
ly, but with more expedition, and with much more 
ease to the patient than in the usual way of cutting 
the prepuce from before backwards. In this manner 
the incision is always made at different strokes, by 
which the cut is apt to be ragged and unequal, where- 
as in the other it is done at once, and in any direction 
that the operator may incline. 

Some advise the incision to run on the side of the 
penis, and others along the back of it. The difference 
in general is not material, but the former appears to 

* Chapter X. Section r. 



228 OF THE PHYMOSIS Ch. Ill, 

me to be preferable, from the matter either of the cut 
itself, or of concealed chancres not being so apt to 
lodge between the prepuce and glans, as when the in- 
cision is made on the back of the penis. It is proper, 
however, to observe, that there are two circumstan- 
ces, which in this operation, require particular atten- 
tion: the large veins of the penis should be avoided, 
and when chancres are present, the cut ought to run 
as near to them as with propriety it can be made, so as 
to admit of the easy application of proper dressings. 

In the treatment of the parts after the operation, 
some attention is necessary to prevent the edges of the 
divided prepuce from adhering to the glans. I have 
known a good deal of inconvenience produced by this 
being overlooked, and it is easily prevented by insert- 
ing a small pledget of lint between the prepuce and 
glans at each dressing. 

Paraphymosis may happen either from a stricture of 
the prepuce, from a swelled state of the glans penis, 
or from a combination of both. 

When it appears to depend, either altogether or 
chiefly, on a contracted state of the preputium, the 
same applications should be made to it which we ad- 
vised for the phymosis. By the use of warm emol- 
lients the stricture, when in a slight degree, may be so 
far removed, as to admit of the prepuce being drawn 
over it. After immersing the penis for a few minutes 
in warm milk, and rubbing the contracted parts with 
any emollient ointment, we may sometimes succeed by 
applying the fore and middle ringer of each hand be- 
hind the contracted part of the prepuce, and pulling it 
gently forward, while, with the thumb of each hand 
placed upon the glans, we push it firmly backward. 
This I have done in different instances, which other- 
wise would soon have ended in strictures of the most 
confirmed kind. It must, however, be confessed, that 
it is only in the commencement of the disease that this, 
or an) other manoeuvre of a similar kind, will suc- 
ceed ; and there is no room for any such attempt when 
|J|g disease proceeds from a tumefied state ot the glan& 



SeC. XII. AND PARAPHYMOSIS. 329 

When the disease seems either to be entirely owing 
to an enlarged state of the glans, or partly to this and 
partly to a stricture of the prepuce, as sometimes hap- 
pens, we may endeavour to relax the preputium by 
rubbing it with oil, or an emollient ointment; but in 
such circumstances it is evident that the application of 
emollients to the glans would rather do harm. By re- 
laxing the parts affected they would increase the swel- 
ling. Cold astringent applications prove more useful, 
and ought alone to be depended on. In this view we 
advised cloths dipped in brandy, vinegar, and cold wa- 
ter, to be applied to the parts, and poultices, with 
crumb of bread, and a solution of saccharum saturni 
in vinegar and water. But when these do not soon suc- 
ceed in reducing the swelling, we are under the neces- 
sity of removing the stricture by an operation, in or- 
der to prevent the accession of more serious symp- 
toms. When too long neglected the glans is apt to 
mortify, by the contraction of the prepuce putting a 
stop to the circulation of the blood. 

This operation consists in making one or more inci- 
sions into the contracted edge of the prepuce. We 
sometimes succeed by making two or three small cuts 
in different parts of the stricture with the shoulder of 
a lancet. They ought to be carried entirely through 
the skin, and into the cellular substance, and when 
they bleed freely they commonly give immediate re- 
lief; but it must be admitted that these small incisions* 
however numerous they may be, do not prove so cer- 
tainly effectual as one freecut made completely through 
the stricture. The easiest method of doing this is, by 
insinuating the end of a director beneath the stricture, 
and cutting upon it with a scalpel. For this purpose a 
short directory should be used, with a groove open at 
the extremity. 

The incision here does not require any particular at- 
tention. The divided vessels should be allowed to 
bleed freely. This generally lessens the pain, while it 
eo -operates along with the removal of the stricture in 



230 OF THE PHIMOSIS, &C. Cll. Ilf. 

carrying oft* the swelling. Lint, spread with un^uen- 
tuni saturninum, makes the best dressing for the sore. 
It must be remembered that we are now supposing 
that no disease exists in the constitution. When either 
of these affections are conjoined with Lues Venerea, 
as we often find to be the case, the patient cannot be 
rendered safe, nor will the sores produced by the ope- 
ration heal, without the assistance of a course of mer- 
cury. 



As the first symptom of an approaching fihy?nosi$ y is a thickening 
of the prepuce and consequently a difficulty of retraction, our first 
care should be to prevent it : this is most easily effected by rest in 
a horizontal posture, being careful at the same time not to allow the 
penis to assume a depending posture, as in this manner we prevent 
the extravasated fluid from gravitating to the prepuce, which forms 
the principal hindrance to its retraction. Should it at any time be 
found necessary to slit open the prepuce, as is often the case when 
matter is confined under it, a director should first be introduced 
and a division made with a curved pointed bistoury, from within 
upward. It must however be recollected that in cases of great 
inflammation this operation is inadmissible, as there is much risk, 
according to Mr. Hunter, of inducing mortification. 

Some modern surgeons in the treatment of paraphyrnosis, have 
advised the compression of the swollen gland (so as to clear it cf the 
blood) with the fingers of the one hand, while with those of the 
other the prepuce is drawn forward ; and in this way they say a di- 
vision of the stricture seldom becomes necessary. Should a divi- 
sion of the stricture become absolutely indispensable, Mr. Hunter 
advises us to separate the two swellings as much as possible where 
you mean to cut, in order to expose the constricted part ; then take 
a crooked pointed bistoury, pass it under the stricture, and divide 
it. The prepuce is now to be drawn forward, or not, as may be 
found most convenient, 

Ed. 



SeC. XIII. OF WARTS OH* THE GLANS, &C, 231 

SECT. XIII, 

Of War Is em the Glans and Prepuce, and Labia PudendL 

THE Glans, Prepuce, and Labia Pudendi, are fre- 
quently attacked with warty excrescences, on the termi- 
nation of Gonorrhoea. 'They sometimes appear during 
the continuance of the discharge, but more commonly 
at the end of it, when the patient having considered 
fhe cure as complete, is surprized with the appearance 
of this new symptom. 

They rise at first in the form of small points, which 
gradually become larger, and frequently so numerous 
as to cover a considerable part of the penis. In men 
they commonly begin immediately behind the glans, 
and extend, in the form of a ring, round the whole pe- 
nis, near to the junction of the glans and prepuce. They 
afterwards appear indiscriminately on ail the neigh- 
bouring parts, but they are usually more numerous 
upon the prepuce. 

In some cases they are first perceived in the urethra. 
The patient complains of an obstruction to the flow of 
urine, and on separating the lips of the urethra, a red, 
florid excrescence is observed to be the cause of it. I 
have also met with productions of this kind in the ure- 
thra of women. 

These warts are seldom painful ; never, unless they 
proceed to a state of ulceration, which, when they do, 
is always to be considered as the fault of the patient. On 
their first appearance they are always firm and entire,- 
but when they become numerous, if they be not regu- 
larly cleaned, the moisture natural to these parts be- 
comes acrid, and renders them tender ; and this, if it be 
not prevented by timeous assistance, soon terminates 
in painful ulcers. Excrescences of this kind assume 
various forms. For the most part they are single, and 
pendulous, with narrow necks, but in some instances 
they have broad bases; while, in others, a number of 
these smaller warts sprout all from the same root, and 
form excrescences of unequal cauliflower surfaces. 



23£ OF WARTS ON THE GLANS 

When long neglected, as sometimes happens with poor 
people, they acquire such a bulk as to cover the glans 
entirely ; and when in this state they become ulcerated, 
the whole mass assumes such a diseased appearance, as 
with those not accustomed to this branch of business, 
gives a suspicion of their being cancerous. Of this I 
have met with different instances, where the penis, af- 
ter being doomed to amputation, has been saved, and 
the warty excrescences removed. 

It is difficult, perhaps impossible, to ascertain the 
cause of these warts. In some cases they are obvious- 
ly produced from the cuticle, their attachment being so 
slight, that on being removed, the cutis vera, is left en- 
tire : in others they proceed from the skin itself, but I 
never observed them to go deeper than this. 

Whatever tends to excite the flow of an unusual 
quantity of blood to the penis, seems to create a dispo- 
sition in these parts to formations of this kind : hence 
they succeed to various kinds of irritation. We know 
that they are a frequent consequence of the venereal 
irritation, for they often succeed to chancres ; and I 
have known them in different instances succeed to sim- 
ple excoriation, where neither Gonorrhoea nor Lues Ve- 
nerea ever existed. By whatever cause irritation is 
produced in the prepuce and glans, it seems to excite 
a disposition in the small blood vessels of the parts to 
sprout or pullulate, by which these warty productions 
appear to be formed. 

As warts on the genitals are a frequent consequence 
of chancres, they have been always considered as of a 
venereal nature, whether they are the immediate ef- 
fects of chancre, Gonorrhoea, or any other cause. This 
opinion, however, is by no means well founded. Warts 
on these parts may, no doubt occur, while Lues Vene- 
rea exists in the constitution ; and in such instances mer- 
cury must be given before a permanent cure can be ex- 
pected. But in a great proportion of cases, at least 
ninety-nine of a hundred, they appear to be entirely 
local, insomuch that remedies acting only upon the 
constitution have no influence whatever in removing 
them, while they are for the most part, easily carried 



See. XIII. AND PREPUCE, &C. &$S 

off by a variety of applications, which act solely upon 
the excrescences themselves, or rather upon the vessels 
by which they are produced. Nay, they are so evi- 
dently of a local nature, that when they occur in Lues 
Venerea, although they are very apt to return when 
removed while the infection exists in the constitution, 
yet it is very certain that this disease of the habit may 
be complete!} eradicated without any effect being pro- 
duced upon them. The warts which succeed to chan- 
cres commonly remain equally firm and obstinate after 
mercury has been given as they were before, and are 
to he removed by the same means as if the constitution 
had never been affected. This, I may observe, is a 
point which in a particular manner merits the attention 
of practitioners; I mean of such as are not daily ver- 
sant in this branch of business ; for while the opinion 
is retained, as is still the case with some, of warts on 
these parts being in most instances connected with Lues 
Venerea, much mischief is apt to be done by a great 
deal of mercury being given where no advantage can 
ever be derived from it. In the treatment of this af- 
fection I have known the constitution almost ruined by 
one course of mercury after another, without any ef- 
fect upon the warts, and which were afterwards easily 
and speedily removed by remedies applied directly to 
the parts themselves. 

I have mentioned irritation as a cause of these ex- 
crescences, but it is only the slighter kinds of it that 
seem to produce them. They often succeed to a slight 
degree of inflam nation, but I have never known them 
form on parts highly inflamed : on the contrary, much 
inflammation seems to destroy the tendency in these 
parts to the production of warts, insomuch, that our 
most effectual remedies in the cure of these excrescen- 
ces, and for the preventing a return of them, are such 
as always excite a good deal of pain and inflammation. 
They may no doubt be removed more quickly with a 
scalpel or scissars, by tying ligatures of waxed silk 
round them, when they are pendulous, and have nar~ 
row necks, but they are more apt to return when re* 

30 



254 OF WARTS ON THE GLANS. Ch. III. 

moved in this manner, or even when they are destroy- 
ed with caustic, unless some decree of inflammation 
has at the same time heen induced upon the parts. Be- 
sides, ligatures cannot be applied to warts with a broad 
base, which they frequently have; and few patients 
will submit to the use of the scalpel for the extirpation 
of the numerous warts, which in such instances for the 
most part prevail. 

Inflammation for the purpose of removing warts 
might be excited in various ways ; but we necessarily 
prefer that which is the easiest to the patient, and 
which at the same time proves effectual. We some- 
times succeed by bathing the warts and contiguous 
parts three or four times a day with a strong solution of 
crude sal ammoniac, or of corrosive sublimate. And 
a solution of mercury in the spirit of nitre at the same 
time that it acts upon the warts themselves as a caus- 
tic, seems also, by exciting inflammation in the vessels 
of the contiguous parts, to remove or destroy the dis- 
position which first produced them. Prescriptions are 
given for these solutions in the Appendix, Nos. 39, 40, 
and 41. The two former may be used with freedom, 
but the strength of the latter renders it necessary to 
apply it with much delicacy and attention. The parts 
should be merely moistened with a pencil dipped in it, 
nor should this be repeated above once e^ery second 
or third day. 

Tincture of cantharides, applied in this manner, 
sometimes answers; but we find by experience, that 
our success is more certain from the application of 
such powders as irritate and inflame the skin, than 
from the use of the same remedies in a liquid form, 
Savine in fine powder is one of the best for common 
use Common mustard, whether of the white or black 
kind, likewise answers; and I have known the powder 
of betony, and of white hellebore, both separately, 
and mixed in equal quantities, prove successful. 

It the warts and skin lying between them be sprink- 
led over with any of these daily, a sufficient degree of 
inflammation, is, for the most part, soon induced, and 



Sec. xiiL akd prepuce, kd 235 

we know that it has gone far enough when some of 
the smallest begin to shrivel and drop off* At this 
time we ought therefore to desist from any further use 
of the powder, always taking care to renew it from 
time to time, if the inflammation subsides before the 
excrescences are entirely removed. In few instances, 
the warts sprout up again after they were altogether 
carried off. When this takes place, the powder should 
be again applied over the whole seat of the disease, 
and continued till such a degree of inflammation is in- 
duced as the patient can easily bear. They will sel- 
dom or never return again, if the parts at this second 
application of the remedy have been made to inflame 
sufficiently. 

These powders, even in a simple unmixed state, ve^ 
ry seldom fail, but in some patients the warts are so 
firm, and the skin of the prepuce so thick and corru- 
gated, that powders of a more powerfully irritating 
nature become necessary* In such cases a small pro- 
portion of red precipitate, finely levigated, being ad- 
ded to the pulvis sabinse, commonly answers. Calo* 
mel sometimes proves effectual, whether used by itself, 
or mixed with any of these powders, and a pow- 
der composed of equal parts of alumen ustum and 
mercur. precip. ruber, seldom fails. 

Even when warts are seated in the entrance of the 
urethra, they may be treated in this manner, at least I 
have often removed them in this situation by theappli-* 
cation of these powders, and I never knew any harm 
produced by them. In one instance when the wart 
was farther up the urethra than usual, the excrescence 
was completely removed by the puhis sabinse alone, 
but a considerable degree of pain was induced by it, 
which ended in a very copious puriform discharge* 
The urethra became tender and inflamed, through the 
whole length of it, and the running having all the ap- 
pearance of the matter of Gonorrhoea, I suspected that 
a new infection had been communicated. My patient, 
however, assured me that this could not possibly be the 
case, as he had not for many months had any connec- 
tion with women, and there wag no cause to doubt his 



236 OP GONORRHOEA SIMPLEX, Ch. Ill* 

assertion. The running: continued for tlie space of two 
or three weeks, with all the symptoms of a common 
clap, and was cured precisely in the same manner, 
viz. by the use of astringent injections. 



We have succeeded in removing warty excrescences of every 
description, including those of a venereal nature, by the application 
of the undiluted tincture of the oxymuriate of iron. This remedy 
apparently acts solely by its powerful astringent properties ; and 
we have observed that they are much less liable to recur after re- 
moval by this remedy, than after the stimulant and corrosive appli- 
cations of Mr. BelL Ed 



SECT. XIV. 

Of Gonorrhoea Simplex, 

I HAVE endeavoured in different parts of thie 
work to slew that the discharge in Gonorrhoea Viru- 
lenta is the effect of inflammation excited in the ure- 
thra and contiguous parts by the matter of infection 
being applied to them. In the end of the preceding 
section a case is mentioned, in which symptoms occur- 
red exactly similar to those produced by Gonorrhoea 
Virulent a from the application of an irritating powder 
to the urethra ; and there is reason to suppose that they 
may at any time be induced by whatever excites in- 
flammation in any part of that membrane. A puri- 
form discharge from the urethra, induced in this man- 
ner, and without any connection with an infected per- 
son having taken place, may be denominated Gonor- 
rhoea Simplex, 

We have already had occasion to see that a discharge 
frequently occurs in females, usually termed fluor al- 
bus, which, in particular circumstances, very much 
resembles Gonorrhoea Virulenta** 

* Vide chapter ii. section 10- 



SeC. XIV. OF GONORRHOEA SIMPLEX. 237 

In men, we often meet with a disease exactly similar 
to this ; where a copious discharge of matter takes 
piacc from the urethra, attended with a scalding heat 
in voiding urine, and all the other symptoms of Gon- 
orrhoea, and where there is no suspicion of infection 
being communicated. 

There is nothing more necessary than for practition- 
ers to be aware of this, particularly the younger part 
of the profession, who are apt to suppose that every 
discharge of matter from the genitals, especially in 
men, ought to be considered as venereal. But al- 
though this is undoubtedly true in a great proportion of 
cases, yet every practitioner of experience must have 
met with many instances of the reverse, and in which the 
reputation of the most virtuous people might have 
been ruined, were the distinction of which we are now- 
speaking overlooked. I have met with different in- 
stances of men newly married being seized with this 
symptom, in some of which, although there was at 
first sight much cause for suspicion and anxiety on the 
part of the husband, yet on being informed by a per- 
son on whose judgment they placed confidence, that a 
running of this kind is not unfrequently induced by 
other causes, and that the discharge which liad newly 
taken place, would probably shew 7 , by its ending more 
quickly than Gonorrhoea Virulenta usually does, that 
it uas of a different nature, they soon became less 
anxious, and at last were convinced of their fears hav- 
ing been altogether groundless. 

In like manner, I have in different instances been 
consulted by women, who, on finding their husband's 
linen stained with matter, have fancied that they them- 
selves had been injured by them; and the imagination 
being once affected, we all know how difficult it is in 
such matters to set it right. I was some time ago con- 
sulted by a lady in circumstances of this kind, who, 
from the cause I have mentioned, had long been redu- 
ced to a state of the greatest distress and misery. Her 
mind was in the first place deeply afflicted with the 
supposed misconduct of her husband ; and she wa$ 



238 OF GONORRHOEA SIMPLEX. Ch. lit 

fully convinced that she herself laboured under almost 
every symptom which attends the venereal disease* To 
this she was in a great measure led, by the opinion of a 
midwife, who unfortunately informed her, that from 
much experience in matters of this kind, she w 7 as con- 
vinced that she was poxed, and desired her to apply to 
me. Instead of this, she put herself under the care 
of one at a distance from town, where she resided, and 
who, from not having much experience in matters of 
this kind, was easily induced to believe that symptoms 
took place which did not exist but in the imagination 
of the patient. There was no external mark of dis- 
ease, but she complained of pains in her bones; se- 
vere pains in the parts of generation and loins ; uneasi- 
ness in the nose, throat, &c. In short, she had perused 
a modern treatise on the Lues Venerea, by which she 
had become acquainted with the symptoms of that dis- 
ease, almost all of which she now imagined that she 
laboured under. 

A complete course of mercury, besides a variety of 
other medicines, were given in the country, but no ad- 
vantage being derived from them, the patient came un- 
der my care. It appeared at once that she was diseas- 
ed in imagination only, for I did not find, on the most 
minute inquiry, that any symptom of the Lues Venerea 
had existed from the first. She acknowledged, that at 
different times, both before and after marriage, she had 
been much distressed with the fluor albus ; but this 
was the only disease of which she ever complained ; 
and it never was of long continuance. 

I endeavoured to convince her that she was perfectly 
sound, that she never had the disease, and that the 
matter which she had seen on her husband's linen, and 
which was the only foundation of her suspicion, was 
either produced by his connection with her while she 
was distressed with fluor albus, or by some other cause 
of a nature equally innocent. All this, however, would 
have proved ineffectual, but I luckily had an argu- 
ment in my power which brought conviction along 
with it, and which in the course of a few days, made 



SeC. XIV. OF GONORRHOEA SIMPLEX. 239 

all her symptoms vanish, which otherwise might have 
been of the most permanent nature. At the very time 
when she suspected her husband to have given her the 
infection, he had consulted me by letters, which I 
preserved, in which he expressed his astonishment at 
the sudden appearance of a discharge of matter from 
the urethra, accompanied with heat and uneasiness 
along the whole course of the passage from the glans 
to the bladder. He never had been infected with Gon- 
orrhoea, and having had no connection with any other 
woman than his wife, of whom he could not entertain the 
least suspicion, he concludes his first letter by enquiring 
whether or not such symptoms ever originate from 
other causes than intercourse with an infected person, 
and at the same time wished that such medicines might 
be sent to him as would as quickly as possible put 
a stop to the discharge. In my answer to this, 
which I also preserved, I mentioned several causes by 
which a discharge from the urethra may be excited, and 
especially the effect of repeated intercourse with wo- 
men labouring under fluor albus, where the discharge 
is more acrid than usual. I at the same time sent him 
an astringent injection, desiring that it might be used 
if the discharge did not soon disappear. In a subse- 
quent letter he informed me that he had been perfectly 
convinced by. my account of it that his disease was of 
an innocent nature; and as a proof of it he mentioned, 
that it went entirely off in the course of eight or ten 
days, without the injection, or any other remedy, be- 
ing employed. A sight of this correspondence, which 
I was enabled to shew, could alone remove the distress 
under which my patient had long laboured. 

I have since that period had occasion to know that 
her husband has at different times had a return of the 
discharge from the urethra, in some instances from ex- 
posure to much cold, fatigue, or wetness, and repeat- 
edly from connection w 7 ith his wife when she laboured 
under fluor albus. 

This happened with a patient w T ho never before had 
any discharge from the urethra ; but a running is more 



240 OF GONORRHOEA SIMPLEX. C!l. HI. 

particularly apt to occur from causes of this kind, in 
such as have been frequently liable lo Gonorrhoea Vir- 
ulenta. I know many of this description who uniform- 
ly experience a return of the discharge on being; ex- 
posed to much bodily fatigue, particularly much rid- 
ing on horseback, orjoltingina carriage on a rough 
road, on (heir being overheated with wine, or having 
more connection than usual even with sound women. 

The irritation excited in the urethra by a stone in 
the bladder will, in some instances, induce a very co- 
pious discharge of matter. When this takes place 
from the bladder itself, the matter comes off mixed 
with the urine, and in no other manner; but when it 
proceeds from the urethra only, as often happens, it 
assumes all the appearances of Gonorrhoea Virulenta, 
and passes off whether any exertions be made to emp- 
ty the bladder or not. 

We are led to understand that people who are much 
employed in working among the warmer kind of spi- 
ces are very liable to a scalding in making water ac- 
companied with a discharge of purulent-like matter 
from the urethra. It is more particularly apt to occur 
in those who work chiefly among Cayenne pepper: 
Nay, it has been known to happen from a person car- 
lying a few pounds of this article about with him for 
sale. 

The most frequent cause of strictures in the urethra 
is Gonorihcea Virulenta; but they also occur from 
other causes. They have been met with in all periods 
of life, even where patients have never had any pre- 
vious discharge from the urethra. They are particu- 
larly apt to occur in people advancing in years, be- 
tween the sixtieth and seventieth year of age and some- 
times later. A person who in his youth has suffered 
much with Gonorrhoea Virulenta, is very liable to be 
attacked about this period with strictures in the ure- 
thra but, i hey likewise iiappen, as I have observed 
above, where no car.se of this kind can be given for 
■them; and in whatever manner thev are induced, they 



SeC. XIV. OF GONORRHOEA SIMPLEX. 241 

are very constantly attended with a plentiful discharge 
of purulent-like matter. 

In some, these strictures have been attended with 
such a concurrence of circumstances, so similar to 
those which occur in Gonorrhoea, that the best practi- 
tioners have at first been deceived with them. Where 
the irritation in the urethra has been considerable, sym- 
pathetic swellings have occurred in the glands of the 
groin; and one or both testicles have swelled from the 
same cause. 

It is generally known, that a discharge may at any 
time be excited from the urethra, by the use of stimu- 
lating bougies. This has in different instances been put 
in practice, where violent pain and other bad symp- 
toms have been induced by the sudden stoppage of a 
Gonorrhoea, but it has also been advised for the same 
purpose, that is, for exciting a discharge of matter, 
merely for the removal of pain, where neither Gonor- 
rhoea nor any venereal symptom had ever taken place; 
and it has never failed when the stimulus is of a suffi- 
cient strength of being attended with this effect. 

We are informed by authors, that gout has in some 
instances been productive of a discharge of puriform 
matter from the urethra ; and I have not a doubt of 
its happening in rheumatism. Of this I have met with 
different well-marked instances, where a flow 7 of mat- 
ter from the urethra has alternated with pains in the 
knees, and other large joints; and among labouring 
people accustomed to work much in water, such as 
ditchers, a discharge of this nature is by no means un- 
frequent. A patient of mine, who annually takes a 
great deal of exercise in following game, is always 
seized with a discharge of matter from the urethra 
when he goes in search of ducks, by which his feet 
and legs are kept immersed in water for several days 
together. 

Other causes might be mentioned, by which a dis- 
charge from the urethra is at times produced, in every 
respect similar to the matter of Gonorrhoea Virulenta, 
but these are sufficient to shew that it mav frequently 

31 



242 OP GONORRHOEA SIMPLEX. Ch. Ill, 

occur from causes of ' the most innocent nature, and in 
persons entirely blameless. Of this, all who have done 
much business in this branch of practice will be easily 
convinced, as instances of it are often occurring ; but 
the distress which the want of discrimination in mat- 
ters of this kind is apt to excite, is often so great, not 
to individuals alone, but to the families with which 
they are connected ; and I have happened to meet with 
so many disagteeable occurrences of this kind, which 
might easily have been prevented, that I judged it 
proper in this manner to take particular notice of it. 

The fact being established that all the usual symp- 
toms of Gonorrhoea Virulenta may be excited by a 
variety of causes, may be considered as an additional 
proof of the matter of Lues Venerea, and of that 
disease being different ; for although the matter produ- 
ced in this manner in the urethra is so similar to that 
of Gonorrhoea communicated by impure coition, that 
the one cannot be distinguished from the other, yet no 
person ever imagined that the symptoms of Lues Ve- 
nerea could be produced by any of these, n^r by any 
cause whatever, but the absorption ol the matter of 
that disease itself. 

It may also be remarked, that this opinion of the 
difference between these two diseases is farther con- 
finned by the method of cure being the same, what- 
ever may have been the cause of the running. Whe- 
ther the matter discharged from the urethra be excited 
by infection communicated by a person labouring un- 
der Gonorrl oea Virulenta, or by any of the causes I 
have enumerated of Gonorrhoea- Simplex, the method 
of treatment might not to be varied. It is true that 
the latter will, for the mos! part disappear, whether 
any remedy be employed for it or not ; but this will 
also happen with Gonorrhoea Virulenta. A cure, how- 
ever, will be obtained much more speedily by a time- 
ous and proper use of injections than inany other man- 
ner ; and if this is admitted in one variety of the dis- 
ease, it will be found equally applicable in the other. 
So far, indeed, as my observation goes, the discharge 



SeC. XIV. OF GONORRHOEA SIMPLEX. 243 

in Gonorrhoea Simplex is not more readily affected by 
the internal exhibition of medicines than we have 
shewn to be the case in Gonorrhoea Virulenta, while 
a proper application of an astringent injection very 
seldom fails in removing it. When, however, it seems 
either to depend upon general debility, or to be much 
connected with this state of the system, we find from 
experience that cold bathing, and whatever tends to 
restore the loss of time that has taken place, proves 
more obviously useful here than in Gonorrhoea Viru- 
lenta. 



« Such a complaint," says John Hunter, " as a discharge (from 
the urethra) without virus is known to exist by its coming on when 
there has been no late connection with women and likewise by its 
coming on of its own accord where there had never been any vene- 
real complaint, nor any chance of infection." 

Having neglected the opportunity which occurred in the early 
part of this volume, of offering some remarks on the subject of 
Ophthalmia as proceeding from Gonorrhoea Virulenta, wc now pro- 
ceed to notice it. It will not be much misplaced", since Gonorrhoea 
Simplex is frequently productive of the same disease, and the ob- 
scurity which appears to envelope the history of both, leaves us 
only the power of stating a few opinions which of late years have 
been introduced into notice by writers of some celebrity. 

That Ophthalmia Of a violent kind sometimes occurs from a sup- 
pressed Gonorrhoea, is not only the opinion of our author,* but of 
other medical writers, among whom we may name Van Swieten. 
Swediaur, Plenek and Scarpa. — The symptoms are peculiarly vio- 
lent, the tunica conjunctiva and eye-lids become highly inflamed, 
there is great intolerance to light, a purulent discharge from the 
eye similar to that which had been suppressed in the urethra, and 
not unfrequentiy the disease becomes so deep seated, as to destroy 
the organ. Cases of this kind are related in which the suppression 
of the Gonorrhceal discharge proceeded from the use of astringent 
injections, and it has been observed that the ophthalmia chiefly occurs 
in the inflammatory state of Gonorrhoea! — Swediaur remarks that 
the disease has never occurred in women. The method of cure 
should be of the most speedy and powerful kind. Frequent bleed- 

* See page 29. 

f Edmonston on Ophthalmia. Mr. "Ware has however observed, that it com- 
monly appeared some time after the exhibition of mercurials for the cure of 
Gonorrhoea and the Editoi-s of the Edinburgh Med. and Surg. Journal remark 
that in a most violent case which occurred to them, and m which there was a. 
total destruction of the eyes, the Gonorrhoea! discharge was not suppressed 



2H OF GONORRHOEA SIMPLEX. Ch. IIL 

ings, powerful purges, and in fact all the agents calculated to di- 
minish inflammation are indicated. In spite of these Dr. Edmon- 
ston observes, that " the disease often runs its rapid course without 
being apparently affected by any application, and the loss or recovery 
of sight seems to depend entirely upon the comparative mildness 
or severity of the attack." 

Mr. Ware, a surgeon of eminence in England has advanced an 
opinion in a late publication, that the disease, called Egyptian Oph- 
thalmia, which proved so destructive to the army serving under Sir 
Ralph Abercrombie, both during and subsequent to the campaign, 
is intimately connected with and resembles the Gonorrheal Ophthal- 
mia, particularly since he has observed in most of the cases a con- 
nection between the ophthalmy and a morbid affection in the urinary 
canal : — He also argues their identity from a resemblance in the 
course of the disease. In reply it has been urged that the symp- 
toms in Gonorrhceal Ophthalmia are rarely of so violent a nature in 
proportion to the frequency of the complaint, whilst in the Egyp- 
tian disease, the sufferings of the patient are almost intolerable, and 
blindness is a common consequence. By some writers, the latter 
disease is sup posed to originate from a specific contagion, and it is 
objected that if a transfer of matter from the urethra to the eye was 
the cause of it, it would have occurred much more frequently.— 
The subject requires further investigation in order to place either 
opinion on a firm basis. 

For some ingenious remarks on the sympathy supposed to exist 
between the urethra and the eve, we refer the reader to Edmonston's 
Treatise on Ophthalmia, in which the probability of the disease ori- 
ginating in some cases from the direct application of the Gonor- 
rhoea! matter is also investigated. Ed, 



KM) OF THE FIRST VOLUME 



TREATISE 



on 



GONORRHOEA VIRULENTA, 



AND 



LUES VENEREA, 



BY BENJAMIN BELL* 



&IJTBER «F THE ROYAL COLLEGE OF SURGEONS OF IRELAND AND EDINBURGH/ 

ONE OP THE SURGEONS TO THE ROTAL INFIRMARY, AND FELLOW OF 

THE ROYAL SOCIETY OF EDINBURGH. 



WITH NOTES, 

.frDAPTED TO THE PRESENT STATE OF PRACTICE IN THOSE DISEASE?, 



VOL II. 



ALBANY : 
PUBLISHED BY E. F. BACKUS, 

KO, 65, STATE-STREET, 



1814, 



TREATISE 

ON 

GONORRHOEA VIRULENTA, 

AND 

t 

LUES VENEREA. 
CHAPTER IV. 

ON LUES VENEREA. 

SECT. I. 

General Observations on Lues Venerea. 

THE Lues Venerea, Syphilis, or Venereal Disease, 
was first described with accuracy by the authors 
who flourished about the end of the fifteenth century. 
This induced many to imagine that it was not previ- 
ously known in Europe; and Columbus with his fol- 
lowers having about this period returned from their 
first expedition to the West Indies, it has been suppo- 
sed that they brought this disease along with them. 
That the venereal disease might be met with by 
Columbus when he first landed in Hispaniola, I will 
not dispute. Like many other diseases, it might not 
be peculiar to one set of people, or confined to one 
hemisphere of the globe; but mrny arguments might 
be adduced to shew that it was well known in the old 
continent, and that it prevailed among the Jews, 
Greeks, and Romans, and their descendants long be- 
fore the discovery of America. This would lead, 
however, to a great length of discussion ; and being 



8 GENERAL OBSERVATIONS, Cll. IV C 

more a matter of curiosity than of real utility, I shall 
not enter farther upon it at present. 

Various definitions have been given by Nosologists 
of Lues Venerea, but the symptoms of the disease are 
so numerous, and the appearances which it assumes 
are so complicated, that no definition sufficiently com- 
prehensive and accurate, can be given of it. In some 
instances it appears in a particular spot only, and con- 
tinues apparently local for a great length of time ; 
while in a great proportion of cases it soon contami- 
nates the whole system, producing a greater variety of 
symptoms than perhaps any other disease with which 
we are acquainted. 

Different opinions have prevailed respecting the 
manner in which Lues Venerea may be communica- 
ted, but it is now certain, that it can be produced in no 
other way than by direct application of the matter of 
contagion to the surface of the body ; or by passings 
as other hereditary diseases do, from parents to their 
children. The virus cannot be carried, as was once 
imagined, from one person to another by the atmos- 
phere, but it may be applied in various ways so as to 
communicate the disease. 

1. In a great proportion of cases the disease is giv- 
en by one person to another in coition. The venereal 
matter resting upon one or more points, excites small 
inflammatory pimples termed chancres, from which it 
is carried by the absorbents into the system, for the 
most part producing, in its way, obstruction and swel- 
ling in the contiguous lymphatic glands; and thus 
forming buboes in the groins. 

2. It is frequently given by a diseased child to a 
nurse, in which case the nipples first become sore, and 
the matter as it passes into the circulation, excites 
swellings in the glands of the axilla. 

3. An infected nurse can scarcely give suck with- 
out communicating the disease to the child. When 
this happens from venereal sores in the nipples, sores 
of a similar nature form on the lips of the child, and 
the matter from thence is taken up by the absorbents. 
But a child may a!?o be infected merely by sucking 



Sec. I. ON LUES VENEREA. 9 

the milk of a diseased worrlan. In this case, the dis- 
ease does not always appear at first about the mouth 
of the child : It proceeds more readily to contaminate 
the system than to produce any local effects, Many 
indeed allege that the disease cannot be communica- 
ted in this manner, and are of opinion, that a child can- 
not be infected merely by the milk of a nurse; I am 
convinced, however, from a variety of facts, that the 
opinion I have adopted is well founded ; but we shall 
have occasion to consider it more particularly here- 
after. 

4. The foetus may also be infected as it passes from 
the uterUs by the matter of venereal sores in the pu- 
dendum of the mother. Of this I have known differ- 
ent instances. In such cases, one or nrrore sores first 
appear in particular parts, from whence the matter is 
carried by the absorbents into the system. 

5. I have known different instances of the disease 
being given to midwives in delivering women with 
venereal sores about the pudendum. 

6* In whatever manner the matter of Lues Venerea 
is applied to a wound, or to an inflamed or ulcerated 
surface, the disease will, in a great proportion of cases, 
be produced. Surgeons, in dressing venereal sores, 
are -sometimes infected in this way ; and the disease 
has been communicated by performing the operation 
of blood-letting with a lancet that had previously open- 
ed a bubo. 

7. Although we find in most instances of this dis- 
ease, either that the matter has been directly applied 
to a wound or to an ulcer, or that by its own acri- 
mony it had induced both inflammation and suppura- 
tion before absorption took place, yet cases some- 
times occur in which nothing of this kind can be dis- 
covered, and where the matter is absorbed while 
both the cutis and cuticle remain entire, This will 
most readily happen where the cuticle is thin, as is 
the case in the glans penis and lips. Hence the sys- 
tem has, in different instances, been infected by mat- 
ter left upon the lips in kissing, and in drinking out 

VOL. II. 2 



10 GENERAL OBSERVATIONS Ch. IV. 

of a cup recently used by an infected person, and in 
some of these without any ulceration being induced. 

This mode of receiving venereal infection is not a 
frequent one, but as I have met with it in various in- 
stances, while the possibility of its existence is deni- 
ed by many, I thought it right to mention it, in order 
to prevent those mistakes, and that mischief in prac- 
tice which might arise from the prevalence of such an 
opinion. 

So readily does the venereal poison enter the sys- 
tem, that it can scarcely be applied to any part of the 
surface of the body but with considerable hazard. 
For the reasons that I have mentioned, absorption 
will occur with more certainty in some parts than in 
others ; but I know, from various facts, that scarcely 
any part of the skin is too thick to prevent it, particu- 
larly if the parts have been rendered tender or irrita- 
ble, either by inflammation or any other cause. Nay, 
it sometimes happens where no affection of this kind 
is perceived. In two instances buboes occurred in the 
axil la, and the patients were poxed by the matter 
of venereal sores being applied to the fingers where 
the skin was sound ; and in another, the disease was 
communicated by the patient wearing the same 
breeches which he had used three months before, 
when labouring under extensive venereal sores of the 
penis and scrotum, but of which he had been entirely 
cured. He knew that some of the matter had occa- 
sionally dropped upon the breeches, but this did not 
occur to him till the disease appeared about the time 
I have mentioned, in the form of a large ulcer on the 
upper part of the penis, and without even the possibil- 
ity of his having received the infection in any other 
manner. 

It is somewhat remarkable that the venereal virus 
should so readily enter the system when applied to 
any part of the surface of the body, when we find, 
from a variety of facts, that the absorbents of the 
stomach and intestines do not receive it. The mat- 
ter of venereal sores, when mixed with water used 
for washing them, has, in various instances, been 



Sec. I. ON LUES VENEREA. J 1 

swallowed by mistake ; but we have no instance of pox 
being produced by it. , 

In whatever way the matter of Syphilis is applied 
to the absorbents, when it has once entered the sys- 
tem, the effects which result from it are nearly the 
same; but at present, I mean, in a great measure, to 
confine the description of the disease to its rise and 
progress in the most ordinary form of it, where the in- 
fection k communicated by one person to another in 
the act of coition,, 

The plan which I mean to pursue is, in the first 
place, to give an account of the different symptoms 
of Lues Venerea in the order in which they commonly 
appear; and as our being able to ascertain the appear- 
ance of every symptom with as much certainty as pos- 
sible is an object of the first importance, I shall de- 
scribe each symptom under a distinct head, and at the 
same time shall point out such circumstances as most 
clearly serve to distinguish it from other affections to 
which it bears a resemblance. 

2. I shall offer a few observations on the nature of 
the venereal poison. 

3. An account of the different remedies used in 
Lues Venerea, particularly of mercury, and its prepa- 
rations. 

4. I shall treat of the employment of these remedies 
in the different symptoms of the disease. 

5. Of Lues Venerea, as it appears in new-born in- 
fants. 

6. Of some peculiarities of form under which this 
disease has appeared in Scotland and in Canada. 

7. I m^an next to treat of prophylactics, or the 
means of preventing infection. 

8. To consider how far Lues Venerea is ever pro- 
ductive of other diseases ; and, 

9. To give in an appendix formulae of the medicines 
enumerated in the preceding parts of the work. • 



12 OP THE SYMPTOMS Cil. IV, 

SECT. It 

Of the Symptoms of Lues Venerea. \ 

J J. General Observations. 

THE venereal disease appears occasionally, as I 
have already observed, in a great variety of for ins. 
For the most part it occurs locally at. .first upon some 
part of the surface of the body, usually upon the ge- 
nitals, from whence it proceeds, and commonly with 
some regularity, to affect every part of the system, 
In others, the first symptoms which take place indi- 
cates an affection of the constitution, and the disease, 
instead of appearing upon the surface of the body, af- 
fects either the throat, bones, or tendons. 

When Lues Venerea is not interrupted in its pro- 
gress by the use of mercury or other remedies, the fol- 
lowing is the order in which the symptoms commonly 
appear, viz. chancres ; buboes; ulcers and inflamma- 
tion in the throat; ulcers in the mouth and nose; erup- 
tions, or blotches, on the surface of the body; ulcers 
in different parts; nodes, and swellings in the perios- 
teum, bones, and tendons; excrescences about the 
anus; swellings of the testes; loss of hair from all 
parts of the body; blindness, loss of hearing, and oth* 
er anomalous symptoms. In this order I shall proceed 
to treat of them. 

$ 2. Of Chancres. 

The first effect which usually results from the ap- 
plication of the matter of Lues Venerea to any part 
of the surface of the body, is a slight degree of inflam- 
mation. The part becomes itchy, red, and in some 
degree painful ; and nature endeavouring to wash away 
the irritating cause, a quantity of serum is thrown 
oyt under the cuticle, in the form of a small bqil or 



SeC. II. OF LUES VENEREA. 13 

pimple. This soon bursts, and leaves a sore of a cor- 
responding size, foul and sloughy at the bottom, with 
hard retorted edges, and which, from the corroding 
appearance which it assumes, has by the French been 
denominated Chancre, a term which we have also 
adopted. 

Chancres do not appear at any certain period after 
the application of the virus 1 have known them form 
in less than twenty-four hours, while in others six 
weeks have elapsed. Three or four days is the most 
frequent period. The patient at first feels a sense of 
litulation over all the glans, and this is often produc- 
tive of a frequent desire to void urine. On examin- 
ing the parts some degree of tenderness is often per- 
ceived over the whole, but the chancre itself is seldom 
at first larger than a millet seed. 

The cause of chancres appearing at such different 
periods after the matter of infection has been commu- 
nicated, is not always obvious ; but we may suppose 
it to depend in some degree upon the acrimony of the 
matter, and this again upon the matter being more or 
less diluted with serum, mucus, or pus. It may also 
in some measure depend upon the state of the parts to 
which the matter is applied. As these are more or less 
irritable, inflammation will more or less readily take 
place from the application of the virus ; and where 
the parts to which it is applied cannot be irritated, and 
where inflammation is not therefore produced, no 
chancres will ensue. 

Chancres appear occasionally over all the external 
parts of generation, and in some instances, even on 
the contiguous parts. I have known them form over 
the whole scrotum, on all parts of the penis, and even 
on the lower region of the abdomen, immediately 
above the pubes. They may indeed form on all the 
soft parts of the body, "but they are most frequently 
seated on the glans penis, and on the preputium near 
to its connection with the glans; the former being cov- 
ered with cuticle only, and the latter being a thin pro- 
duction of the cutis vera, both are easily made to in« 
flame. We also remark that chancres are frequent 



14 ' OF THE SYMPTOMS Ch. IT. 

about the frcenum, from the doublings of the skin be- 
ing here particularly apt to retain the matter by which 
they are produced. In some instances they form on 
the very point of the glans, and even altogether within 
the verge of the urethra. Here, as well as when near 
to the frcenum, they prove always more troublesome, 
and more difficult of cure, than in other parts of the 
penis. 

There is sometimes only one chancre, but for the 
most part we meet with two, three, or even more; 
nay, in some instances, they cover the prepuce almost 
entirely. In this case, when they run into one ano- 
ther, none of them are distinct, and the whole, when 
thus connected, give the appearance of a foul ulcer, 
with hard edges, an unequal surface, and discharging 
a foetid, ill-conditioned matter. 

The colour, quantity, and consistence of the matter 
of chancres is exceedingly variable. It is usually of 
a dirty green colour, and often tinged with red, the 
consistence thin, and the quantity large in proportion 
to the size of the sores. This last circumstance may 
be owing to the contiguous parts being apt to inflame, 
and although not ulcerated, to afford matter which we 
cannot easily discriminate from the discharge of the 
chancres. 

In a great proportion of cases the appearances of 
chancres are so nearly the same that no person of ex- 
perience can be under any doubt concerning them ; 
but, as they sometimes vary in size, form, and other 
circumstances, some discernment is occasionally re- 
quired to distinguish between them and sores of a dif- 
ferent kind. The diagnosis of chancres is indeed a 
point of much importance in practice. We are apt to 
conclude that every sore upon the genitals is of a ve- 
nereal nature, a circumstance which has subjected 
many to much inconvenience and distress. Mercury 
is commonly prescribed, but where the case is not ve- 
nereal no advantage is derived from it, and the patient, 
after a tedious and painful confinement, finds the sores 
in no better state than at first. In all such affections we 



Sec. ir. of lues venerea, 15 

should recollect that the penis and contiguous parts are 
liable to excoriations, pimples, and other eruptive com- 
plaints, equally with the rest of the body ; nor should 
we too rashly suppose, as is frequently done, that all 
such appearances proceed from a venereal cause. It is 
not often indeed that we can be in doubt upon this 
point, for chancres, in most instances, are so distinctly 
marked that there is no room to hesitate concerning 
them ; but where they do appear in a doubtful form, 
and especially if the patient has been liable to affec- 
tions similar in appearance, and where no venereal 
taint could be suspected, some time should always be 
allowed to pass before any decisive opinion is given, 
When sores of this kind are of a siaiple, innocent na- 
ture, they usually heal in the course of a short time, 
merely by being kept clean, while they will gradually 
become worse, if they are venereal, if mercury be not 
employed, or if they are not treated with eseharotie 
or astringent applications. In all such circumstances 
no remedy should be made use of that can either pro- 
mote or retard the cure of the sores, till we are ena- 
bled by farther observation to ascertain of what na- 
ture they really are. 

We are most apt to dnubt of the nature of these 
sores, when, instead of being small and circumscribed, 
they spread and occupy more space than chancres usu- 
ally do. A real venereal chancre is seldom so large 
at first as the base of a split-pea, and the edges of the 
sore are elevated, somewhat hard, and painful ; but 
although this is very commonly the case, yet, in a few- 
instances, it is so much otherwise, that instead of a small 
circumscribed sure, we observe a slight superficial 
ulceration, not attended either with pain or hardness, 
and which, by the consequences alone, we find to be 
venereal. In all such cases certainty will be obtained 
from time and observation, and in no other manner. 
Nor can any harm ensue from a short delay ; for while 
this will commonly determine the question, the same 
course of treatment will afterwards prove effectual 
which would have done so at first ; and in this man- 
ner sores may be often cured in the course of a few 



16 OF THE SYMPTOiYife th. Vti 

days, in which, if a course of mercury had once been 
entered upon, confinement for several weeks would 
have been judged adviseable. 

Besides the variety of chancres which I have men- 
tioned, there is another, which it is proper to notice* 
Instead of appearing in the form of small circumscri- 
bed pimples, or superficial sores, such as I have de- 
scribed, they become suddenly elevated into extensive 
vesications* In these, a thin, clear lymph is some- 
times contained ; but more frequently the lymph is 
tinged with blood. The livid appearance with which 
this is accompanied gives at first cause to suspect that 
mortification may ensue, and accordingly chancres of 
this description have usually been judged to be of 
a more dangerous nature than others. I have not 
found, however, that this is the case. Their colour 
seems to depend entirely on the quantity of blood 
mixed with the serum which they contain, and on their 
contents being discharged, and the cuticle removed, 
the parts beneath have the appearance of a clean, ex* 
coriated surface^ without being afleeled in any other 
manner. 

When chancres are properly treated from their 
commencement, they commonly assume a healing ap- 
pearance in the course of a few days ; but in some in- 
stances owing to neglect, in others to some peculiarity 
of constitution, and perhaps occasionally to the mat- 
ter of infection having been particularly virulent, in 
stead of becoming clean, and of a red, healthy com- 
plexion, and which they always do before a cure takes 
place, they become daily more foul, and at the same 
time more extensive, and if their progress be not 
stopped by a judicious external treatment, combined 
with a proper course of mercury, they proceed to 
form sores of a very considerable magnitude. The 
danger from these, when seated in the preputium, is 
inconsiderable; but in the glans, this variety of chan- 
cre is apt to go to such a depth as to prove very alarm- 
ing. The danger is sometimes great from the hcemor- 
ihages with which they are accompanied, and we are 
often astonished at the rapid progress of the sores, In 



Sec. iio of lues venerea; 17 

some instances (hey extend so quickly as to destroy a 
great part of the penis in the course of a few days. 

This rapid progress, which chancres in some instances 
make, is, for the most part, supposed to depend upon 
some peculiarity in the constitution of the patient ; for, 
in general, chancres remain circumscribed, and nearly 
stationary, for a great part of their duration. But I 
have reason to think, that in some instances it proceeds 
from the nature of the matter by which they are pro- 
duced: I conclude that it is so from chancres of this 
description being much more frequent at particular 
times than at others, and from observing them at the 
same time in different people receiving the infection 
from the same woman. About two years ago I met 
with more instances of this phagedenic chancre in the 
space of three or four months than I had seen for sev- 
eral years before, and in four of them the infection was 
traced to the same woman : The chancres in all of them 
appeared early, and made such rapid progress that very 
troublesome haemorrhages occurred from them in the 
space of three or four days from their first appearance; 
and in a small town to which I was lately called for 
an alarming haeuiorrhagy, produced by an ulcer of this 
kind, the surgeon in attendance informed me that in 
the space of a few weeks he had met with three instan- 
ces of the same nature, in which the infection was also 
traced to the same woman. 

Chancres of every kind, and in all their stages are 
liable to inflame when roughly treated, particularly 
when the parts are much fretted by walking, or riding 
on horseback. This ought to be attentively guarded 
against, for inflammation not only promotes the absorp- 
tion of the venereal virus, as we shall more particu- 
larly hereafter have occasion to mention, but when it 
affects the preputium, phymosis is commonly the con- 
sequence, and it proves always an untoward occur- 
rence, as it prevents free access to the sores beneath, a 
point of the first importance in the treatment of chancre. 

In women, chancres have precisely the same appear- 
ance as in men. They occur chiefly upon the internal 
parts oHhe labia pudendi, on the nymphee, clitoris, and 
. vol. u, 3 



1# OF THE SYMPTOMS Cil. IV. 

entrance of the vagina and urethra, but they are sel- 
dom or never altogether within either of these passa- 
ges. They are most frequent about the under part of 
the labia, owing to the matter producing them being 
most apt to rest here, and from the same cause they 
often form upon the perinaeum, near the anus. In this 
situation they prove always highly distressful, and are 
more apt to terminate in deep and extensive ulceration, 
than in parts not so liable to be injured; for here they 
are fietted by every motion of the limbs, nor can the 
patient be seated without pressing upon them. 

Whether in men or women, chancres on parts cov- 
ered with firm skin have a very different appearance 
from such as occur upon parts more thinly protected. 
Instead of small circumscribed pimples, such as I have 
described, the skin appears red and tender for a day or 
two, and without being previously elevated into small 
vesicles, ulcerations breakout at once. A foetid viscid 
matter oozes out, which, on being removed, leaves the 
bottom of the sores of a deep red colour, and their 
edges inflamed and ragged, and however entirely this 
matter may be wiped off, it is soon renewed, and in the 
space of a few hours forms into a thick firm crust, 
which either remains till it be torn off, or till it be com- 
pletely separated from the contiguous parts by the for- 
mation of new matter beneath. This kind of sore is 
most frequent in parts covered with hair, particularly 
about the root of the penis in men, and above the 
pubes, and on the perinseum in women. 



On the subject of Chancre we take the liberty of offering a few 
remarks, in addition to those of our author ; rather as references to 
the authorities on this subject, than as even an abstract of their 
observations. 

Mr. Howard in his Treatise on the Lues Venerea, notices, what 
lie terms, "the slightly irritable aphthous Chancre," from its resem- 
blance to the Aphthae in children. He observes that the two first 
stages of it, viz: that of /rimfile, and that of pustule, are generally 
passed over unnoticed before the disease is suspected, and the first 
symptom that gives alarm is an uncommon itching on one or more 
points of the glans or prepuce. Upon inspection a small ulcer is 
perceivable, not deep, nor perhaps larger than a moderately sized 
pin's head, the circumference and bottom of which are thickened 



SeC. II. OF LUES VENEREA. 19 

and hard, with a surface yellowish, or resembling a small slough, 
but with somewhat of the orange coloured tint, like the fat of rusty 
bacon. — This singular appearance is frequently discoverable by the 
flaked eye at an early stages but will be best known by viewing the 
part with a good lens. At this stage it smarts a little on being irri- 
tated, but the most common inconvenience is a slight itching, and 
very moderate inflammation. — In this species of chancre the poison 
sometimes appears to remain dormant for a considerable length of 
time, and Mr. Howard observes that in one case a chancre was so 
inconsiderable at the end of six weeks, after the infection had been 
received, that the patient was only ordered an alterative course of 
mercury, the consequence of which was that it terminated in a ve- 
nereal eruption. This he states as a case which seldom occurs. — 
The older the date of the infection, no matter how slight or trifling 
the ulcer may seem, the more difficult it will be to assure the pa- 
tient from secondary symptoms in future ; because the disease is, in 
this case, quickly verging towards the time of eruption. — The chan- 
cre or chancres are for the most part devoid of pain, or considerable 
inflammation, for many days ; and in some instances for weeks ; 
they are small in size, and though attended with considerable itch- 
ing, yet the glans and prepuce, continue uninflamed, and without 
phymosis, — This state continues often for weeks, producing only a 
solutio continui ; but local irritation, intemperance of any kind, and 
even the stimulus of mercury, before the decisive change has been 
produced on the disease, will change the condition of these ulcers 
from a quiet to a very uneasy and painful state. A symptom in this 
stage sometimes occurs, which has been thought peculiar to Gon- 
orrhoea, a slight chordee from the extension of the inflammation to 
the cellular texture of the urethra and corpora cavernosa penis. 

Mr. H. notices what he terms, , for distinction sake) the livid ir- 
ritable chancre. It is, from the beginning, painful to the touch; 
instead of the aphthous it has a livid or somewhat blackish hue, with 
a corroded kind of surface and hollow ragged edges ; it creeps on 
at a great rate, eating away and undermining the surrounding skin, 
irregularly, like a small spreading phagedaenic sore ; it is attended 
from the beginning with much more discharge, than the preceding 
species, and that discharge seems to be highly acrimonious. The 
ulceration is extremely irritable, producing great pain, and phymo- 
sis. — Excoriation and bubo come on much sooner in this, than in the 
preceding species of chancre, probably on account of the matter 
being taken up from an abraded surface of larger extent. Between 
these two kinds of chancre, Mr. Howard observes there are seve- 
ral intermediate varieties, all however referable from their ap- 
pearances, to one or other. — He describes a particular form, 
which he considers more malignant than either of the above. It 
commences with a brownish kind of scab, somewhat depressed, as 
if the parts were rotten beneath, with the margin of this scab separa- 
ting from the sound skin. Intimately connected with the livid irritable 
chancre descrioed above, is a Chancrous Excoriation extending over 
the glans and prepuce, and originating probably from an abrasion of 
the sebaceous glands. Chancrous Excoriations maybe distinguish; 



20 OF THE SYMPTOMS 01). IV. 

ed from similar affections of these parts, by their sooner degenera- 
ting into ulceration. Should the prepuce become inflamed, and 
a phymosis take place, the complaint may still be known by the vio- 
lence and pain of the inflammation and the colour of the discharge, 
which is most frequently of a greenish yellow. The surfaces of 
these sores appear as if they were covered superficially with half 
melted lard or tallow. 

All excoriations however, on these parts are not chancrous, and 
the latter should be carefully distinguished from mere irritation from 
violent friction, from the excoriation which frequently arises from the 
sebaceous matter of the glandular odoriferse becoming acrid from neg- 
lect, particularly in hot weather ; from scorbutic and scrophulous 
affections of the glans and prepuce, £cc. For a more detailed ac- 
count of the nature and variety of chancre, we refer to the work of 
Mr. Howard, which we have so frequently quoted. Also, the Trea- 
tise on Morbid Poisons, by Dr. Joseph Adams, Chap. Chancres^ 
and particularly to the very learned work of Mr. John Hunter on this 
subject, Ed. 

$ 3. Of Buboes. 

A venereal bubo is a painful swelling of a lymphatic 
gland, produced by absorption of the venereal virus. 
The. whole surface of the body having absorbents 
spread upon it no contagious matter can be applied to 
any part of it but with the risk of injuring the consti- 
tution. In various instances of Lues Venerea the sys- 
tem is infected by the matter being carried directly in- 
to the blood, but in others a swelling previously takes 
place in one or more of the lymphatic glands lying be- 
tween the part to which the matter is first applied and 
the heart. 

These glands being formed by convolutions of the 
lymphatic vessels, are apt to be obstructed by any ir- 
ritating matter which enters them. Hence a venereal 
bubo is a very frequent symptom of the disease ; and, 
as it is also one of those which give the greatest dis- 
tress and perplexity both to patients and practitioners, 
I shall give a more minute description of it than might 
otherwise have been necessary. 

The points of most importance in the history of 
buboes, and which we shall therefore be particularly 
anxious to ascertain, are, the state of parts most fa- 
vourable to their production ; their most frequent situ- 
ation ; the appearances which they assume at different 



Sec. II. OP LUES VENEREA. £\ 

periods of their duration, and the means of distinguish- 
ing them from other swellings which they resemble. 

I have already observed, that the venereal virus may 
be absorbed where the skin is sound and entire : Hence 
Lues Yenerea may take place where no external mark 
can be discovered upon the part to which the matter 
of infection was applied. It must be admitted that 
this is by no means a common occurrence ; but I have 
met with it in such a number of well marked instances, 
that I have no more doubt of the fact than of any oth- 
er that falls daily and clearly within our observation. 
It has happened too in almost all of these, that a bubo 
was one of the first symptoms of the disease. I have 
now upwards of twenty cases recorded of bubo taking 
place where not a vestige could be traced either of 
previous Gonorrhoea, chancre, or excoriation. 

As the first two or three cases of this which occurred 
to me gave rise to a good deal of difficulty, by the 
uncertain and undecisive practice w 7 ith which they 
were attended, I think it right in this manner to make 
it known. At the time it was an established opinion, 
as it still is with many, that buboes cannot take place 
without some previous formation of matter in the con- 
tiguous parts. In the cases to which I allude the cure 
was therefore protracted to a great length ; for till the 
nature of the disease became more obvious, and which 
sometimes did not happen till other symptoms appear- 
ed, the use of mercury, from which alone relief could 
be obtained, was commonly postponed. The swelling 
was either supposed to proceed from a strain in walk- 
ing or riding, or to originate from scrophula, by which 
a good deal of time was lost to no kind of purpose. 

In a former part of this work we have seen that swel- 
lings take place in the glands of the groin from inflam- 
mation produced by Gonorrhoea: These have, with 
sufficient propriety, been termed sympathetic buboes, 
and they are by no means uncommon ; but the real 
idiopathic bubo, proceeding from absorption of syphi- 
litic matter, is, in a great proportion of cases, preced- 
ed by some obvious local mark of the virus in the con- 
tiguous parts, most frequently by chancre. The mat- 



2*2 OF THE SYMPTOMS Ch. IV. 

fer passes so evidently from the chancre along the lym- 
phatics to the contiguous glands, that one or more of 
these vessels are often found hard, and in a state of 
enlargement, in their course from the sores to the 
glands. This, in some instances, may happen from 
inflammation excited by the virus ; in others, it may 
he altogether the effect of obstruction to the passage 
of the lymph. In some cases the lymphatics in this 
state- of enlargement become totally unfit for the pur- 
poses of absorption ; abscesses form in them ; and on 
these bursting, they are succeeded by troublesome 
sores. 

Chancres, in all their stages, and in every period of 
theii duration, will occasionally produce buboes; but 
it is worthy of remark, that they seldom occur but 
with previous marks of inflammation : Hence buboes 
are most frequent in the incipient state of chancres, 
while the inflammation by which they were produced 
still prevails. Indeed more buboes take place during 
the first eight or ten days from the appearance of chan- 
cre than in any other period of equal extent in the 
whole course of the disease. When the original in- 
flammatory state of chancres is over, and the parts 
are merely ulcerated without being painful, they will 
continue in this situation for a great length of time, 
without any tendency to buboes being perceived, till 
inflammation is by some cause or other induced upon 
them: Hence we find buboes very frequently occur 
soon after caustic has been applied to chancres, and 
not uncommonly after the parts have been dressed 
with precipitate or any irritating ointment. The pain 
which these occasion tends, in the first place, to create 
some degree of inflammation, to which buboes very 
frequently succeed. 

Ii is not however the higher degrees of inflammation 
which prove most favourable to the production of bu- 
boes. When inflammation suddenly takes place to a 
great height, and spreads along the lymphatics leading 
from chancres the system is not apt to be infected. 
These vessels appear to be deprived by a great degree 
of inflammation, of the power of absorption, probably 



SeC. II, OF LUES VENEREA, 23 

by their being rendered impervious ; but it is equally 
certain, as I have ai ready observed, that every slight 
degree of inflammation, as well as whatever tends to 
stimulate the extremities of absorbents, excites them 
more or less to action, and thereby tends to increase 
their power of absorption. Of this we have daily 
proofs in the practice of inoculating for the small-pox, 
where we find that infection verv rarely takes place* 
perhaps not once in a thousand instances, if the wound 
at which the matter of infection was introduced is not 
excited to inflame : Hence the more irritation that is 
excited at the time of inoculation the more certainly 
the disease is communicated. 

We may here mention another instance of the eff-ct 
produced by the irritation of lymphatics in promoting 
absorption. In the application of unctuous substances 
to the surface of the body, particularly in the use of 
mercurial ointment, the power of friction is universal- 
ly admitted ; and we cann >t suppose that it acts in any 
other manner than by stimulating the absorbents of the 
parts. Some indeed have asserted, that in matters of 
this kind no advantage is derived from friction, and 
that the absorbents would act with equal influence al- 
though the ointment was merely applied to them ; but 
this is so directly contrary to the observation of all 
who have attended to the effects of friction in such ca- 
ses, that no farther notice need be taken of it* 1 

It has be en remarked that old venereal ulcers do not 
produce buboes, and this has given rise to an opinion 
that the matter produced by these sores is not of a ve- 
nereal nature, that is, that it would not contaminate 
the system were it carried into the blood by the ab- 
sorbents. Mr. Hunter was, I believe, the first who ad- 
vanced this opinion, and I do not know that it has yet 
been publicly controverted ; but so far as my observa- 
tion goes I can decidedly say that it is not well found- 
ed. I admit that buboes, or swellings of the lymphat- 
ic glands, do not often proceed from venereal sores of 
long duration, particularly from such as arise from in- 

* It seems to be surprising- that Mr. Hunter should hazard an opinion te this 
effect. Tide Treatise en the Venereal Disease bv John Hunter. 



24 OF THE SYMPTOMS Cb. IV 

fection of the system; but although they are not fre- 
quent, yet in various instances we meet with them. I 
have seen them in the neck, from ulcers in the throat; 
in the groin, from sores on the toes and feet ; and in 
the axilla, from ulcers on the fingers and hands : and 
the cause of their not being more frequent may be ea- 
sily explained. We have just had occasion to remark^ 
that absorption of the matter of Lues Venerea does 
not often happen if the parts to which it is applied do 
not inflame. Now we know that it is one of the most 
characteristic circumstances of old venereal sores, their 
being seldom accompanied with inflammation. This is 
particularly the case in ulcers of the throat, where in- 
flammation seldom takes place to any distressful height. 
Swellings of the glands in the neck very seldom hap- 
pen therefore from thjs cause, but still they are occa- 
sionally met with ; and I believe that they happen as 
frequently here, in proportion to the frequency of the 
true venereal inflammation which takes place in these 
sores, as in any other part of the body. They occur 
more frequently in the groin and armpit, from ulcers 
on the extremities, than they do in the neck from ul- 
cers in the throat ; but this happens obviously from ul- 
cers of these parts being more apt to inflame than ve- 
nereal ulcers in the throat ; and it serves as a farther 
proof of the effect of inflammation in increasing the 
absorbent powers of the lymphatics. 

In a former work I have shewn the propriety of diV 
linguishing venereal ulcers into two kinds. Chancres I 
would denominate primary ulcers, being the root or 
source of all farther infection, while all those may be 
denominatedsymptornatic which arise from the syphilit- 
ic virus havingentered the system. That chancresshould 
be more of an inflammatory nature than symptomatic ul- 
cers, and therefore that the matter produced by them 
should be more apt to stimulate the absorbents is not sur- 
prising ; for we can readily suppose that the matter of 
these old ulcers must be rendered mild by being dilu 
ted. Even the matter of chancres become Jess viru- 
lent when the disease has been of long duration ; and 
the discharge of an ulcerated bubo, although the bu- 



Sec. II, OF LUES VENEREA. 25 

bo itself was produced by a chancre, is evidently of a 
milder nature than the discharge of chancres ; for we 
seldom or never see new buboes arise in the glands ly- 
ing contiguous to an old bubo in a state of ulceration : 
But we cannot surely imagine that this proceeds from 
the matter of these sores not being venereal. I believe 
it to depend upon the cause which I have mentioned- 
The matter of a sore in this situation must be contin- 
ually diluted by the lymph which is at all times pas- 
sing into the gland. This may render it so mild that 
it will not be capable of stimulating the contiguous 
glands, so as to form obstructions in them. It will 
rather pass easily along with the lymph into the general 
mass of blood ; nor will it produce any immediate or 
obvious effect, even when it has entered the system ; 
for when thus 'diluted by all the blood in the body, 
some quantity must be required to accumulate before 
any irritation will ensue ; and till some degree of irri- 
tation is excited no evident effect will take place. It 
must either exist in such a state of acrimony, or in 
such quantity as to be capable of exciting irritation in 
some part of the solids, otherwise no mark of disease 
will occur from it : Hence may be accounted for all 
those instances of Lues Venerea breaking out at ve- 
ry distant periods after infection was communicated, 
and of the difference which in this respect we meet 
with in different patients ; the disease in some break- 
ing out in the course of two or three weeks from the 
time of infection, while in others it does not appear 
for eight, ten, or twelve months. Nay, there is rea- 
son to think that in some it has not appeared till several 
years have elapsed, and of which I could adduce such 
proofs as seem to render it certain. 

That the matter of old venereal sores is capable of 
communicating infection few I believe will doubt. 
Many decisive proofs might indeed be given of it, 
but I shall only mention the following. When the mat- 
ter of a chancre excites swelling hi the contiguous 
glands we have few instances of the virus passing into 
the constitution. The glands will remain enlarged for 
a considerable time without any mark of the system 

VOL. II* 4 



26 OF THE SYMPTOMS €b. IV. 

being injured, probably from the mailer of infection 
being stopped in its progress by the diseased state of 
the glands; but when buboes become ulcerated, if 
mercury be not employed, the disease, for the most 
part, soon breaks out in the throat and other parts of 
the body from the matter of these secondary or symp- 
tomatic sores Laving entered ttie circulation. In some 
instances, as I have mentioned above, a considerable 
time elapses before the constitution is affected by the 
matter of these sores, but it scarcely ever fails of 
shewing itself at last, and not unfrequently in the 
course of a short time from the ulceration of the bubo 
taking place. 

When to this we add, that sores of this description 
are cured in the same manner 'with every other symp- 
tom of the venereal disease ; that they daily increase 
in depth and extent till mercury is employed ; and 
that they commonly put on a healing appearance in 
the course of a short time after this medicine has been 
used, no doubt can remain of their being altogether 
venereal. Every practitioner knows that in the treat- 
ment of venereal ulcers, sores sometimes remain after 
every attempt that we can make for curing them, and 
long after the virus of the disease is removed by mer- 
cury. This, as we shall hereafter have occasion to 
mention, may happen from various causes; but it is 
not this state of these ulcers which we have now been 
considering: It is the real venereal ulcer of which we 
are now speaking, where the nature of it has not been 
changed, nor the virus of the disease removed by the 
use of mercury. 

Venereal buboes are most frequently seated in the 
groin. This necessarily happens from the manner 
in which Lues Venerea is usually communicated ; for 
it is the lymphatic glands most contiguous to the parts 
first infected that most commonly swell. There are 
few instances indeed of the virus passing through these 
and fixing upon others : Hence buboes arising from 
ulcers of the lips and gums are seated under the 
tongue, and beneath the lower jaw ; from ulcers in 
the throat, the glands of the neck become affected ; 



SeC. II. OF LUES VENEREA, 27 

from sores on the fingers and bands, the glands swell 
about the wrist, elbow, and in the axilla ; and the 
glands about the knee, and on the upper part of the 
thigh, are most apt to swell from sores of the toes 
and feet 

In each groin, and somewhat higher than the root 
of the penis, there is a cluster or string of lympha- 
tic glands, chiefly formed by the lymphatic vessels 
of the penis and contiguous parts. It is the most 
contiguous of these glands to the penis that are most 
frequently obstructed by the matter of chancres. It 
is proper, however, to remark, that buboes some- 
times occur from the same cause in a siring of glands 
lying upwards of an inch lower than these, owing to 
the lymphatic vessels of the penis passing in some in- 
stances out of their usual course and stretching down 
to these glands. From want of attention to this struc- 
ture of parts, buboes in this set of glands have com- 
monly been supposed to proceed from the system be- 
ing infected, unless where they could be obviously 
traced to an ulcer in the foot or leg ; but we may here 
observe once for all, that buboes never occur from a 
general affection of the system alone. They proceed, 
I believe, in every instance from matter absorbed 
from a particular spot, and producing, as we have 
already perceived, obstructions in the lymphatic glands 
lying in its course to the heart So evidently do bu- 
boes originate from local affections, that in chancres 
of the perns it is commonly the glands in the corres- 
ponding groin that swell. When a chancre is seated 
upon the freenum,.or on any other part of the middle 
of the penis, the glands in both groins are equally apt 
to be affected ; but when the chancre is confined to 
one side of the penis, or to one side of the scrotum, 
we meet with few instances of the glands in the oppo- 
site groin being obstructed. 

In a great proportion of cases only one of the 
whole string of glands becomes affected ; but occa- 
sionally it is otherwise. I have known four distinct 
buboes on one side, and three on the other at the 
same time, but here there have always been more 



28 OF THE SYMPTOMS Ch. IV. 

chancres than one ; for the most part indeed the pe- 
nis in such cases is nearly covered with sores. 

Were the whole lymphatic glands between the heart 
and the part at which the matter of Lues Venerea 
enters the system, liable to be affected with it, this 
disease would be productive of still worse consequen- 
ces than commonly ensue from it. Glands situated 
wit: in the cavity of the abdomen would swell and 
suppurate, from which the greatest danger might be 
ex eeted ; but this does not happen. Scarcely an 
instance can be adduced of any internal glands being 
affected by the matter of syphilis ; but this does not 
depend, as some have imagined, upon the tendency 
of tiiis disease to affect the more external parts of the 
body only. The most obvious cause of it is, that the 
venereal virus is always absorbed from the surface of 
the body • we have seen that it is always the first 
glands it meets with in which obstruction occurs ; and 
I have suggested what appears to be the most proba- 
ble reason of the glands situated beyond such as are 
affected at first not being liable to suffer in future, viz. 
the stop which the swelling of the first of these glands 
gjves to the farther absorption of matter, and the di- 
luted state of the matter in the progress of the disease, 
by which it becomes incapable of exciting that de- 
gree of irritation necessary to produce absorption, or, 
if absorbed, that it is rendered so mild as not readily 
to produce obstruction in any of the glands to which 
it is carried. If the matter of Lues Venerea was ap- 
plied to any internal part of the body, so as to excite 
ulceration, we have no cause to doubt of the effects 
resulting from it being the same that ensue from the 
external application of it. The contiguous glands 
would be first affected, and from thence it would pro- 
ceed to the rest of the system; but the disease never 
being communicated in this manner none of the glands 
seated internally can ever be affected. 

These circumstances being premised, I shall now 
enumerate the appearances and symptoms of buboes, 
with the means of distinguishing them from swellings 
T?bi'ch resemble them. It must be kept in view that if 



SeC. II. ©F LUES VENEREA, &9 

is the real venereal bubo of which we are now speak- 
ing, and not that inflammatory swelling with which the 
glands in the groin are often attacked in Gonorrhoea. 
A description of that swelling is given in Chap. III. 
Sect. IX. 

The most frequent seat of bubo, as we have seen, 
is in the groin, and a description of it in this situation 
will be sufficient. The first symptom* of bubo is a 
slight degree of pain. This excites the attention of 
the patient, when on handling, a small hard knot is 
discovered. In some cases this is accompanied both 
with pain and tension, stretching along an enlarged 
lymphatic vessel, in the form of a small cord, all the 
way to the penis; but for the most part the tumour is 
distinct, and not apparently connected with any other 
affection. Even where two or more buboes take place 
at the same time, although near each other, they are 
always distinct and unconnected at first, insomuch that 
the patient himself very commonly points them out. 

If mercury or other discutients be not now employ- 
ed the tumour becomes gradually larger, and from be- 
ing, as it commonly is when first perceived, of the 
size of a kidney bean, by the eighth or tenth day, and 
often sooner, it is usually of the size of a pigeon's egg. 
From the first appearance of a bubo there is some de- 
gree of rotundity in the form of it. In the middle it 
is somewhat raised and prominent, and becomes flat- 
tened towards the sides, and this continues during the 
whole progress of the swelling. As the size of the 
tumour increases it also becomes more painful, and the 
pain, which at first was confined to the bubo itself, 
spreads over all the contiguous parts. The patient 
complains upon the slightest degree of pressure, and 
he cannot walk or move but with much uneasiness. 

Even when of this size, buboes will sometimes be 
removed by discussion; but when this does not hap- 
pen, the swelling, which till this period usually retains 
a considerable degree of firmness, becomes in a grad- 
ual manner softer and more prominent; the skin, which 
for some time retained its natural colour, becomes red 
and tender; some degree of fever is apt to take place. 



30 OF THE SYMPTOMS Ch. IT. 

and it is often accompanied with slight shivering fits, 
A fluctuation of matter is at length discovered, at 
first upon the surface of the tumour, and afterwards 
through a considerable part of the whole of it, and on 
this being discharged, either by the tumour bursting 
or by an opening being made into it, the parts are 
found to have all the appearances of a common ab- 
scess containing purulent matter. 

The time which elapses in this progress of bubo, 
from the first appearance of the swelling till matura- 
tion is completed, is exceedingly variable, and de- 
pends upon a number of circumstances; upon the age 
and habit of body of the patient; upon the degree of 
pain and fever which take place; and on the gland be- 
ing superficial or deeply seated ; for we find by expe- 
rience that deep-seated swellings do not so easily or so 
quickly suppurate as those which are immediately be- 
neath the skin. Where the constitution is much re- 
laxed and debilitated, buboes often remain indolent 
and stationary for a great length of time, while during 
the full vigour of health and youth, they usually come 
quickly forward : When accompanied with much pain 
and some degree of fever, from the first their progress 
in general is rapid, while they always advance slow- 
ly when the pain is inconsiderable. This general ob- 
servation may be made upon the maturation of vene- 
real buboes, that they suppurate more quickly than 
glandular swellings of any other kind, and more slow- 
ly than common abscesses in the cellular membrane. 
Those who have not had much experience in this 
branch of business are apt to imagine, from the de- 
scription which they have perused of the appearances 
of buboes, and perhaps from their having met with a 
few instances of the disease in its ordinary form, that 
no difficulty or doubts can occur concerning them ; 
but this is far from being the case. Where a glandu- 
lar swelling, such as I have described, appears in the 
groin, either during the continuance of chancres, or 
soon after sores of this nature have healed, there will 
be no cause to doubt of its being venereal : But bu- 
boes do not always appear in a simple unmixed state, 



Sec. II. OF LUES VENEREA, 31 

They are sometimes combined with other affections, 
where they necessarily assume other appearances; and 
they occur in some instances, as I have already men- 
tioned, without being preceded by the least vestige of 
ulceration. This last circumstance of itself is com- 
monly productive of doubt, but the difficulty is al- 
ways increased when the swelling which takes place is 
not altogether venereal. 

Swellings with which buboes may be confounded, 
and from which therefore it is proper with as much ac- 
curacy as possible to distinguish them, are of different 
kinds. In some cases these swellings occur hi a simple 
unmixed state, in others they are blended with the real 
venereal bubo. 

1. The most frequent cause of this kind of perplex- 
ity, is scrophula. When the venereal disease takes 
place in scrophulous constitutions, buboes as well as 
almost every other symptom, not only become much 
more obstinate, but assume appearances perfectly dif- 
ferent from such as occur in the ordinary form of ei- 
ther of these diseases. Nor is it necessary that prac- 
titioners only should be acquainted with this. It ought 
to be made known in the most unequivocal manner to 
patients, otherwise they are apt to be perplexed and 
disappointed, and to biame those who have the charge 
of them, for what it is not often in the power of art to 
prevent. 

Where evident symptoms of scrophula have previ- 
ously taken place, or where that disease obviously ex- 
ists at the time, there is no great difficulty of convinc- 
ing patients of any symptom of Lues Venerea with 
which they are attacked, being likely to partake of it ; 
but they should also know, that during the continuance 
ot Lues Venerea, symptoms of scrophula frequently 
appear where that disease was not previously suspect- 
ed to exist, and which otherwise might never have ta- 
ken place. Of this I have met with many instances, 
where a scrophulous taint, which had till then remain- 
ed concealed, broke out at once with much violence 
on the system being infected with Lues Venerea. 

We judge that a swelling of this kind partakes of 



32 OF THE SYMPTOMS Gh. 



IV 



scrophula when, instead of yielding to a proper appli- 
cation of mercury, or coming forward to suppuration 
in the time which venereal buboes commonly require, 
it either remains stationary or advances in that slow 
gradual manner peculiar to tumours of a scrophulous 
nature. Tumours altogether venereal do not advance 
so rapidly as common abscesses, but they come much 
more quickly forward than scrophulous swellings. In 
most instances, a venereal bubo that is allowed to suppu- 
rate arrives at full maturity in the space of four or five 
weeks ; often in less time than this, from its first com- 
mencement; whereas, when conjoined with scrophula, 
two or three months will pass over before this takes 
place. The pain, instead of being smart, as happens 
in buboes, is more of a dull obtuse nature. The swel- 
ling at first, instead of being firm, as we have describ- 
ed it to be in buboes, is somewhat soft and compressi- 
ble, like dough; and even when matter is fully formed 
init, the firmness and tension attending it is less. Nei- 
ther is the redness of the teguments, which takes place 
as the swelling comes forward, of such a bright hue as 
in buboes. 

This kind of connection between Lues Venerea and 
scrophula, may, in some instances too be discovered 
by the size of these tumours. The true venereal bu- 
bo is no doubt very variable in point of bulk, but it 
never becomes so large as tumours of this mixed na- 
ture commonly do. Few of the former ever surpass 
the size of a pullet's egor, but the latter very common- 
ly become two or three times larger than this. I have 
at present two instances of this kind of swelling stretch- 
ing from the root of the penis, nearly to the spine of 
the ileum. 

2. Venereal buboes are very apt, in the course of 
their progress, to be attacked with erysipelas. When 
this does not take place till towards the latter stage of 
the swelling no cause for doubt occurs from it, as the 
real nature of the primary affection is previously ren- 
dered obvious. But when it occurs at first, as some- 
times happens, the practitioner, as well as the patient 
is thereby apt to be deceived. Tumours of this kindj. 



SeC. II. OF LUES VENEREA, 33 

instead of being circumscribed, with their limits dis- 
tinctly marked, as happens in buboes, are commonly 
diffused, and terminate in a more imperceptible man- 
ner in the contiguous pails Instead of the vivid com- 
plexion of common inflammation, they are of a more 
deep copper colour, and the inflammation which takes 
place occurs suddenly, instead of approaching in a 
more gradual manner. 

I may also remark, that the pain in these swellings 
accompanied with erysipelas, gives more distress from 
the sensation which it communicates of a burning de- 
gree of heat than w/e ever meet with from these lanci- 
nating pains which take place in the latter stages of 
the true venereal bubo. 

3. Lumbar abscesses have in some instances been 
mistaken for buboes. This, however, may at all times 
be easily avoided, and can never occur but from igno- 
rance or inattention. Any person of experience will 
easily distinguish by examination with his fingers, the 
difference between the one and the other. In the one 
the swelling is seated in the cellular substance, while 
it is in the body of a gland in the other. Whoever has 
once handled these different parts in a tumefied state 
will be at no loss to distinguish between them ; and to 
those who have not had this opportunity it is perhaps 
impossible to mark the difference by any description 
that can be given of it. I may remark, however, that 
these two swellings are for the most part sufficiently 
distinguished by the symptoms which precede and at- 
tend them. If buboes be not always preceded by 
chancres, lumbar abscesses are universally attended 
with pain about the small of the back and in the loins, 
Tiiis symptom indeed very commonly occurs as a fore- 
runner to the appearance of the tumour in the groin, 
and almost in every instance, before the tumour ap- 
pears, the patient is much debilitated by the fever with 
which he is attacked from the first formation of the 
disease, and which never in any considerable degree 
happens in bubo. 

4. In some cases, both inguinal and femoral herniae 
have been mistaken for buboes. Of this I have known 

VOL. II, 5 



34 OF THE SYMPTOMS Cll. 1\\ 

different instances with patients ; nor is it surprising 
that it should be so, for both kinds of swelling appear 
nearly in the same part; they are neither of them at- 
tended with any alteration in the colour of the skin* 
when they first appear, and they are both, for the 
most part, accompanied with some pain : but still the 
difference between them is so obviously marked that 
one can scarcely suppose it possible for any practition- 
er, however ignorant he might be, to fall into any dif- 
ficulty upon this point, did we not know that indif- 
ferent instances it had happened. Hernice have not 
only been mistaken for buboes, but buboes have been 
treated as hernia?. 

Besides the very marked distinction which occurs 
between buboes and hernia, in the appearances and 
other circumstances immediately connected with the 
tumours, and with which every practitioner ought to 
be acquainted, hernia is for the most part sufficiently 
distinguished from the other by the sickness, obstruc- 
tion of the bowels, and other symptoms with which H 
is accompanied, and which ought also to be so gener- 
ally known that to enumerate them more particularly 
would be altogether unnecessary. 

5. Ulcers in the feet and legs, from whatever cause 
they may arise, occasionally produce swellings in the 
glands of the thighs : These, in some instances, have 
been mistaken for buboes. The chief means of dis- 
tinction are these ; our knowledge of the existence of 
such a sore as we have found by experience to be pro- 
ductive of tumours of this kind ; the seat of the tu- 
mours, these swellings being commonly on the fore 
part of the thigh, and somewhat lower than the ordina- 
ry seat of buboes; and lastly, their being attended with 
little or no pain, and very seldom proceeding to sup 
purate, but rather continuing indolent, and nearly of 
the same degree of hardness from the first. Even; 
when they do contain matter the skin seldom loses its 
colour; a circumstance which never happens with bu- 
boes in a state of suppuration. 

Women labouring under the venereal disease are 
equally liable to buboes with men ; and the disease is 
so exactly similar in both that a description of it m 



Sec. IL OF LUES VENEREA. 35 

the one sex renders it almost unnecessary to speak of 
it in the other. The only circumstance in which they 
are different is the situation of the tumours. 

From the course of the lymphatics not being exact- 
ly the same in women the site of buboes in them must 
necessarily be different. I met with one instance of 
the swelling exactly upon the middle of the mons ve- 
neris ; for the most part, however, they are situated 
on the course of the round ligaments, near to where 
they enter the abdomen, or higher in the groin, some- 
what nearer the pudendum, than in men. These 
last become equally large with buboes in men ; but 
the others, it has been remarked, remain small, and 
still more circumscribed than buboes in their ordinary 
situation. 

The symptoms we have hitherto been describing, 
vi?.. chancre and bubo, are at first always local ; that 
is, they are never produced by, although they are ve- 
ry commonly productive of, what may be called the 
constitutional state of the venereal disease. This has 
induced some to treat of these symptoms as distinct 
and unconnected with the constitutional affection; and 
there would be much propriety in their doing so, were 
it possible to determine when the matter of chancre or 
of bubo has entered the system or not. But so far as 
I know this has never been done ; and there is much 
cause to imagine that no attempt towards it will ever 
prove successful. Some ingenuity has been shewn in 
endeavouring to ascertain the time which must elapse 
between the appearance of chancre and absorption by 
the lymphatics; and even during this period, the dis- 
ease, it is said, should be considered as local. To me, 
however, all such attempts appear to be both futile and 
dangerous. The point in question can never, in my 
opinion, be ascertained ; and while the contrary idea 
prevails, the constitution would in many instances be 
injured, as it would be very apt to lead, as with some 
it lias already done, to a very hazardous practice, a 
dependence in the treatment of these symptoms upon 
local remedies, Chancres and buboes may both re- 
main in a local state for a great length of time. Naw 



36 OF THE SYMPTOMS Ch. IV. 

it is possible that their cure might sometimes be ac- 
complished without any of the matter arising from 
them entering the constitution ; but as this is mere 
conjecture, as we have no method of knowing when 
this might be the case, and as we know from daily ob- 
servation that in almost every instance the constitu- 
tion is injured even by the slightest degree of these 
symptoms, I judge it in every respect better to treat 
of them as constitutional affections. 

The next symptom we have to describe is univer- 
sally allowed to originate from the virus when it has 
entered the system. 



On the subject of buboes as a primary symptom, there are a vari- 
ety of "pinions; many respectable writers, agree with our author 
that true venereal bubo is sometimes met with when no chancre 
has preceded, from the direct absorption of the virus Mr. How- 
arc: observes, " When it arises alone, without any precedent or at- 
tendant symptom, and without any apparent ulceration on the parts, 
which are usually in the first instance affected, the same general 
affection of the system, the same venereal pains, eruption and at- 
tack on the periosteum, and other internal surfaces, may follow 
from tnis as from chancre j even though the latter should nerer ap- 
pear." 

Dr. Adams in his observations on morbid fioisons, maintains the 
Opposite opinion and says, " If bubo is the only symptom when our 
patient is first introduced to us, it becomes an important object, to 
learn the exact history of its first appearance, of every attendant 
crcumstance, and of every remedy which has been applied. If the 
tumour is. all that has appeared, to say the least, the chances are 
that it is not venereal. Such a disease was well known to Celsus ? 
and even in the milder climate of Italy was often found extremely 
troublesome. It is contrary to general analogy, that the glands 
shouid ever be affected by any contagion without the appearance of 
primary local action, if the law of the poison is to produce a prima- 
ry local action where it is first applied : I know of no instance on 
record, in which the constitution has been affected by a bubo, with- 
out a previous chancre, or Gonorrnoea. Lastly, as I am aware, that 
many nonest and ingenious men maintain a different opinion, I shall 
only add, that I have never seen reason to repent, the not having 
treated such buboes as venereal." 

If (continues Dr. Adams) a bubo has been the consequence of an 
ulcer on the penis, which healed spontaneously, we may be certain 
that it is not venereal. It may be the effect of morbid poison, as 
probably many of Ceisus's were : It may be assisted by, and may 



SeC. II. OF LUES VENEREA. 37 

even heal under the use of mercury : but this will be no proof of 
Its venereal origin. 

If the bubo has not appeared till after the chancre has healed, it 
will often prove venereal, and must be treated as such. If the first 
view we have of the bubo is in its open state, the same enquiries, 
and the same cautions, are necessary as before. The first and 
most important of all these is, whether mercury has been used for 
it, to what degree of constitutional irritation and with what effect on 
the part. The knowledge of all this is absolutely requisite before 
we commence our treatment, and an attention to it, is equally im- 
portant, during the whole progress of cure." (Vide Howard and 
Adams.) Ed. 

% § 4. Of the Venereal Sore Throat. 

From whatever part of the body the matter of sy- 
philis may have enleied^the lymphatics, we find that 
it is more apt to attack the throat than any other part. 
This does not happen, however, at any certain peri- 
od. I have known it fix upon the throat in the course 
of ten days from the first appearance of a chancre^ 
while in some instances it remains perfectly sound till 
several months after every external mark of the dis- 
ease has disappeared. 

In addition to what has already been said upon this 
point I may observe, that the throat, as well as other 
parts of the body, are most apt to be soon affected 
when no buboes take place. When the matter passes 
directly into the system, along the absorbents, the in- 
fection shews itself more early than where it is first 
stopped by buboes, and afterwards taken up by the 
lymphatics on these swellings becoming ulcerated. 

In the venereal sore throat the patient is usually 
distressed with some degree of uneasiness in swallow- 
ing for some days before his attention is much excited 
towards it. He feels a sensation of fulness and ten- 
derness, but not much pain. In some cases this pre- 
vails over the whole throat, but for the most part on 
one side only. Unless there has been some recent 
cause for suspicion the disease is attributed to cold ; 
but the symptoms continuing, and an inspection being- 
made, an ulcer is in most instances discovered on the 
part of which he complained in swallowing. 



38 OF THE SYMPTOMS Cll. IV. 

These ulcers in some cases make their first appear- 
ance upon the uvula, but they are much more frequent 
upon one of the amygdalae. On first inspection they 
are commonly small, but always foul, and accompa- 
nied wilh some degree of fulness or swelling, and 
with an erysipelatous redness of the contiguous parts. 

In most instances the ulcer remains stationary for a 
considerable time, not going deeper than the thickness 
of a shilling, nor spreading to any greater extent than 
it occupied at first ; but in others, unless the^wost ef- 
fectual remedies are immediately employed, tnfe ulcer 
not only becomes deeper, but spreads to a grFat ex- 
tent, and in some cases with such rapidity, that I have 
known the uvula and all the contiguous parts affected 
in the course of a few days. »In some the. ulcer, in its 
course, gives only the appearance ^o^foulness to the 
contiguous parts, which become covered with a yel- 
low coloured slough, somewhat resembling the huffy 
coat of inflammatory blood, while in others it spreads 
in the form of a corroding sore, and destroys all the 
parts as it goes along. It sometimes destroys a great 
part of the tonsil before leaving it, but it more fre- 
quently spreads along the arch reaching from the ton- 
sil, on which it is seated, to the uvula, and which, to- 
gether with the contiguous parts of the velum pendu- 
lum palati, are commonly destroyed before the other 
tonsil becomes affected. 

Even in this advanced state of these ulcers the pa- 
tient seldom complains of much pain, if it be not du- 
ring the action of swallowing. A general uneasiness 
is felt over the throat, but the pain is never so acute 
as the extent and appearances of the sores would give 
cause to expect. Wherever much pain takes place, 
we find that it proceeds not from the sores but from 
that kind of erysipelatous redness with which the 
contiguous parts are very apt to be affected, and by 
which such a distressful burning sensation is sometimes 
induced over the whole throat as renders the patient 
at all times very uneasy. 

Tn some cases of the venereal sore throat this in- 
flammatory redness takes place without any ulcera- 



Sec. II. OF LUES VENEREAr 39 

tinn. If not prevented by mercury, ulcers would no 
doubt form at last ; but I have known the parts re- 
main swelled, and accompanied with that deep copper- 
coloured complexion which is very characteristic of 
these affections, for several weeks together, and with- 
out any degree of ulceration being perceptible. The 
disease in this state, although it is commonly fixed on 
§one side of the throat at first, is very apt to leave it 
suddenly and go to the other; and this we find will 
happen again and again, till the one side becomes ul- 
cerated, by which it is kept fixed to a particular spot. 

Where the throat is affected in this manner, that is, 
where it is attacked both with the venereal virus and 
erysipelas, a very distressful symptom commonly takes 
place, a constant heat and irritation over the whole 
fauces, by which the patient is kept under a perpetual 
df sire of clearing his throat, of an acrid, viscid mucus, 
with which it becomes so much stuffed from time to 
time as to render a great deal of exertion for this pur- 
pose necessary ; and it prevails equallfcat all tin 
even during meals, and when the patrenTshould 
rest. 

That it is chiefly by the irritability which takes place 
here that this acrid mucus is produced I conclude .to 
be the case, from finding ^at aothiwg ' ta^ i fw.) tmxfo~my 
to remove it as soothing anodyne applications, conjoin- 
ed with the internal use of opiates. 

It is commonly too in this- inflammatory state,ofsore 
throat that patients in Lues Venerea are seized with 
deafness. Deafness may happen from other causes, as 
we shall afterwards have occasion to mention, but ira 
this case I believe it to proceed from the inflammation 
spreading to the tuba eustachiana, so as to render it 
impervious. Inflammation may act in producing deaf- 
ness, either by stuffing this passage with mucus, or by 
exciting adhesion between the sides of the duct. In 
the one case the deafness may only be temporary, but 
in the other it must neeessarilv, to a certain decree, 
remain permanent. 

In most instances the venereal sore throat does not 
go deeper than the soft parts ; producing sores, such 



3 pi**- 



40 OF THE SYMPTOMS Ch. IV, 

as I have described, of various degrees of magnitude ; 
but where the disease has either been too long neglect- 
ed, or where mercury and other remedies employed 
do not prove successful, the bones themselves come in 
some cases to sufFer. I have known the body of the 
upper vertebrae of the neck affected in this manner, 
and it not unfrequently attacks the bones of the pal- 
ate and back part of the nose. 9, 

One of the most distressful circumstances which 
practitioners meet with in diseases of the 'hroat is, the 
uncertainty of distinguishing between venereal affec- 
tions of these parts and others which resemble them, 
by which a good deal of time is either altogether lost, 
or employed with much doubt and undecision. From 
this cause alone ulcers are sometimes .allowed to 
spread, where it might easily have been prevented by 
a timeous use of mercury ; and in other instances pa- 
tients are put upon the use of this remedy where it 
ought by no means to be employed. 
^The complaints most apt to be mistaken for venereal 
Wcctions of vSlse parts are, those ulceis which occa- 
sionally succeed to long continued cases of catarrhal 
inflammation, and such as sometimts take place as the 
consequence of too much mercury having been used, 
or of the jn^ient being e^osed to cold while under a 
course of mercury. 

The chief means of distinction between venereal 
ulcers of the throat and such as succeed to inflamma- 
tion are these ; ulcers from inflammation very common- 
ly supervene upon abscesses; they are usually clear], 
and of a florid red appearance, and accompanied with 
a good deal of pain. The venereal ulcer again sel- 
dom or never produces abscess, and in the first place 
it always forms upon the surface. It is never clean 
till remedies have been employed for rendering it so y 
and although it is always accompanied with some un- 
easiness, the pain attending it is never so severe as in 
the other. I may also remark, that in the common in- 
flammatory sore throat the contiguous parts do not 
usually assume that erysipelatous colour which very 
universally takes place in venereal ulcers, nor are 



ScC. II. OF LUES VENEREA, 41 

they apt to induce that plentiful secretion of acrid mu- 
cus* and the symptoms which ensue from it, which we 
have shewn to be frequent consequences of the other. 

We shall hereafter have occasion to speak more par- 
ticularly of that variety of sore throat arising from the 
effects of cold when under mercury, as well as from 
an over-quantity of mercury, having been employed. 
At present I may remark, that this is distinguished 
from the venereal sore throat by a very considerable 
fulness or swelling, not only in both amygdalae of the 
throat, but over tie whole fauces, together with some 
degree of tumefaction of the parotid gland, as well 
as of all the salivary glands; circumstances by no 
means connected with venereal affections of these 
parts. The parts are not so apt to ulcerate as in the 
venereal disease, and any sloughy appearance which 
takes place upon them, instead of being of a buffy 
colour, as happens in the other, is white and milky, 
somewhat resembling those apthous crusts so fre- 
quently met with in the* mouths of new-born infants. 
These sloughs too are more extensive than they ever 
are in venereal sore throats. In the latter they are. 
always confined to such parts as are inflamed, while, 
in the other, they commonly extend a considerable 
way over the contiguous parts. 

The natural unequal 'ties on the surface of the 
amygdalae have, in some instances, when in a state of 
inflammation, been mistaken for venereal ulcers; this, 
however, may always be avoided, and never can hap- 
pen but from ignorance or inattention. 



Mr. Hunter describes the true venereal ulcer in the throat as a 
fair loss of substance ; part being dug out, as it were, from the 
body of the tonsil. He further adds, that it has a determinate edge, 
and is commonly very foul, having thick white matter, like a slough, 
adhering to it, and not admitting of being washed away. Ulcers 
in such situations are always kept in a moist state, and the matter 
cannot dry and form scabs, as it does on sores upon the skin. The 
ulcer is also much more rapid in its progress and generally has 
thickened edges. (Hunter on the Venereal, Philadelphia Ed. p. 295.) 

Dr. Adams observes that although the edges of a venereal ulcev 

YOL. If» 6 



4& OF THE SYMPTOMS Ch. IV. 

in the throat are defined, yet its surface is always ragged and une- 
ven, and of a complexion which can never be mistaken for a clean 
or healthy sore, that is, for a sore disposed to heal. The pus is of 
various colours, from the ash colour to the dusky brown. It is rare- 
ly attended with pain. In other respects, Dr. Adams' description 
agrees with Mr. Hunter. (Adams on Morbid Poisons, 2nd Edc 
p. 167,) 

Mr. Howard has remarked that during the progress of the ulcer- 
ation, the other parts of the gland seem often to be but little affect- 
ed, but they are sometimes enlarged, indurated and even horny. 
The ulcers at first are not unlike the aphthae of children, but soon 
increase in depth and width. The appearance of the true venereal 
ulceration of the throat is compared by Mr. H. to laid or musty, 
bacon half melted. (Howard on the Venereal, Vol. 1. p. 76.) 

It is of the highest importance, as our author observes, to form 
a correct opinion whether an affection of the throat be venereal, or 
not. In addition to the marks put down to distinguish it from a sore 
throat induced by mercury, may be added, a factor of the breath, 
and an increased secretion from the salivary glands ; symptoms 
which are never met with in the pure venereal ulceration. 

The venereal sore throat is distinguished, from the putrid sore 
throat, by the symptoms of general indisposition, quick febrile 
pulse, depression of strength, 8cc. which accompany the latter and 
never attend the former — from common inflammation of the ton- 
sils by the symptoms mentioned by Mr. Bell— from those cases in 
"Which coagulable lymph is thrown out on the surface, occasioning 
appearances, like ulcers, or sloughs, by the greater degree of swel- 
ling in the last and by removing the lymph, when the surface of 
the tonsil will be found free from ulceration — from an ulcerous ex- 
coriation of these parts by the latter being superficial and more ex- 
tensive. (Hunter.) In all cases of Ulcers of the Throat, many of 
which are often scrophulous, a minute attention to the progress of 
the symptoms is necessary to enable the practitioner to ascertain the 
cause of disease. In those instances where any doubt exists as to 
their being venereal, no injury can result from delaying the exhibi- 
tion of mercury. By steadily watching the progress of the ulcer, 
noticing whether it increases regularly, but slowly, and not healing 
duiine this period in any part, the real truth may soon be determin- 
ed, if it should proceed in the course we have described, for a 
few days, its syphilitic character may be considered as well estab- 
lished. (Adams.) Ed. 

§ 5. Of Venereal Ulcers in the Nose and Mouth. 

Chancres, or primary venereal ulcers, rise occasion- 
ally, as we Lave already had occasion to remark, both 
in the nose and mouth; but sores of this description, 
wherever they are seated, having been already de- 
scribed in $ 2. of this section, we are now to treat of 



See. ii. of lues venerea. 43 

those only which originate from the system being in- 
fected. 

Next to the throat the matter of this disease fUes 
most frequently upon the nose, which, so far as I have 
had opportunities of observing, is more apt to be at- 
tacked with it than the month. I need scarcely observe, 
however, that some variety occurs in this- In a few 
cases the mouth is attacked before either the nose or 
throat. In others the disease appears first in the nose ; 
but in a great proportion of cases it follows the pro- 
gress I am now describing; after having for some time 
fixed upon the throat it goes to the nose, if the dis- 
ease is not stopped in its course by a proper use of 
mercury. We may also remark, that although the 
ulcers in the throat should be cured by mercury, if a 
sufficient quantity of the medicine be not employed 
for eradicating the virus, the disease, when it again 
breaks out, will appear most readily upon the nose, 
in the same manner as if no mercury had been made 
use of. This, however, is not universally the case ; 
for in many instances we find it most apt to return to 
the parts where it was last seated, and after again fix- 
ing upon the throat it proceeds to the nose, as it would 
have done at first if no interruption had been given 
to it. 

It does not however attack every part of the nose 
indiscriminately. Soma have remarked that the mat- 
ter ot this disease has a particular tendency to fix upon 
the external parts of the body, that this always happens 
in the first instance, and when it proceeds from these 
to such as are more deeply seated that it does so with 
some regularity, by attacking such parts first as are 
most thuily covered. This, however, does not hap- 
pen with any kind of regularity, and seems only to 
have been noticed for the purpose of supporting an 
opinion. Instead of going first to the skin, which it 
would do were this opinion well founded, the throat, 
as we have just seen, is most apt to be affected ; and 
when it afterwards attacks the nose and mouth, it k 
not even the most external parts of these that are first 
apt to suffer. 



44 OF THE SYMPTOMS (ill. IV. 

In a few instances the disease no doubt appears first 
upon the outward parts of the nose, but in by much 
the greatest number the more internal parts are previ- 
ously affected. The patient at first complains of a 
troublesome stoppage in one of his nostrils, accom^ 
panied with some degree of tenderness and pain at 
a particular point. This is often so deeply seated in 
the nostril that it cannot be seen, being most frequent- 
ly upon some part of one of the ossa spongiosa ; but 
when the under part of the passage is affected, togeth- 
er with a fulness of the membrane of the nose, a small 
foul ulcer is perceived, which is either covered with a 
white slough, or a firm brown crust, and on this be- 
in removed, although the parts beneath may appear 
dean and red, they soon become equally foul and 
sloughy as before. 

I»? the commencement of these affections, the dis- 
ci arge is commonly inconsiderable ; but on a longer, 
continuance, the matter forms in greater quantities, 
when it usually becomes thin and very foetid. Jf the 
ulcer is seated upon any part of the ossa spongiosa, 
tht bone soon becomes diseased, and the matter ac- 
quires a black dirty color; it becomes larger in quan- 
tity, and the fcetor still more considerable than at first. 
In this stage of the disease large portions of these 
bones are apt to separate and come away ; but before 
coming to this length, other symptoms have common- 
ly made their appearance. A weeping eye, as it is 
termed, or a constant flow of tears over the cheek, 
frequently occurs in this stage of the disease, owing to 
the under end of the lachrymal duct, which termi- 
nates behind the os spongiosum inferius, being apt to 
be stopped by the disease of this bone. The sense of 
smelling becomes impaired, and in some is entirely de- 
stroyed ; and the figure of the nose is at last affected, 
in the first place becoming swelled, red, and painful, 
upon the parts immediately above those that are ul- 
cerated, and afterwards losing its prominency by the 
bones of which it is formed coming away. This does 
not happen while the disease is confbed to the spongy 
bones of the nose, but the septum itself becomes af- 



SeC. II. OF LUES VENEREA. 45 

fected, in which case there is always much hazard of 
the face being disfigured by this bone giving way, 
when the nose is apt to fall nearly or entirely flat. 

This is the usual course of ulcers in the nose ; but 
instead of attacking the internal parts in the first in- 
stance, we meet with them occasionally upon the car- 
tilaginous parts of the nose, in which case they com- 
monly begin with some degree of inflammation of the 
skin. After the skin has remained red and tender for 
some time, small ulcerations appear upon it, and these 
at last running together, a sore of more or less extent 
is formed by the whole. Like all other venereal sores, 
ulcers in this situation are always foul ; the matter they 
discharge is thin and offensive, and the skin for some 
way round their edges is of an erysipelatous red co- 
lour. When the cartilaginous substance of the nose 
becomes affected, they often put on a cancerous ap- 
pearance ; nor has mercury the effect of* stopping 
their progress so readily here, as in other parts of the 
body: This has in some instances been the cause of 
venereal ulcers in this part being treated as cancers, 
by which, even after being extirpated, the disease has 
again returned, when a cure might easily have been 
accomplished by the mercury having been continued 
for a due length of time at first. 

Every part of the mouth is occasionally the seat of 
venereal ulcers ; but although they appear from time 
to time on the inside of the cheeks and- on the gums, 
they are most frequent upon the palate and on the 
tongue. In other parts of the mouth the ulcers ap- 
pear without any previous warning, being for the most 
part fully T formed as soon as the part affected is exam- 
ined by the patient, and which is commonly done soon 
after it begins to excite any uneasiness ; but in the pa- 
late no ulceration takes place till the parts have been 
inflamed for some time. A deep copper-coloured spot 
is at first perceived somewhere between the uvula and 
middle of the palate. This at last becomes ulcerated ; 
and it is worthy of remark, that in no part of the bo- 
dy do venereal sores advance with such rapidity as 
they do here. In this respect they are different even 



46 OF THE SYMPTOMS Cll. IV. 

from venereal sores in the throat. These last, as we 
have already had occasion to remark, seldom proceed 
to any great depth, nor do they advance with much 
quickness ; but here their progress is not only rapid 
but they go at once to the full depth of all the soft 
parts covering the bones, and in most instances soon 
do much injury to the bones themselves. I have known 
the bones of the palate become diseased in the course 
of a few days from the first appearance of ulceration; 
and it is by no means uncommon to find a great part 
of the velum pendulum palati destroyed in the space 
of a few days from the time that it was first perceived 
to be affected. 

Venereal ulcers of these parts have at times been 
mistaken for, and treated as ulcers of a very different 
kind, but with due attention this may perhaps in every 
instance be prevented. We are more apt to fall into 
the error of treating other sores as venereal. 

Both in the mouth and nose venereal ulcers have 
been mistaken for cancerous sores; and in the nose 
they sometimes bear a resemblance to herpetic affec- 
tions. From both of these we distinguish them not 
only by the history of each particular case, but by 
the different appearances which these affections actu- 
ally assume. Where a patient with herpetic eruptions 
on other parts of his body is attacked with sores of a 
similar nature upon his nose or lips, there will be rea- 
son to conclude that they originate from the same 
cause; but where this is not the case, and particularly 
when it is found that the patient either labours under 
Lues Venerea at the time, or that he was lately affect- 
ed with it, and not properly cured, this of itself will 
give ground to imagine that they are venereal. Her- 
petic sores seldom go to a greater depth than the skin ; 
whereas venereal ulcers, whether on the nose or lips, 
are apt to penetrate deep into the parts upon which 
they are seated. 

Cancerous sores are distinguished from these, as well 
as from every other variety of ulcer, by the schirrous 
hardness in the parts affected with which in every part 
of the body they are accompanied ; and they are par- 



Sec. ir. of lues venerea. 47 

iicularly distinguished from venereal ulcers by the 
smart shooting pains which Ihey always excite; a 
symptom which does not usually occur in the others. 

The mouth is equally liable with the throat to sores 
from an over quantity of mercury, and from patients 
being exposed to cold when under the use of it. These 
are more difficult to distinguish than any others from 
the real venereal ulcer; for besides the resemblance 
which in some circumstances they bear to them, as 
they commonly occur while the patient is under cure 
of some symptom of syphilis, this of itself is apt to 
create suspicion concerning them. Independent of 
this, the very situation of the sores gives some cause 
to suppose that they may be venereal, so that we are 
readily induced to consider every ulcer on these parts 
as being of this nature. 

Sores arising from this effect of mercury, although 
somewhat resembling the true venereal ulcer, are read- 
ily enough distinguished from it by whoever has paid 
attention to this branch of business. Venereal ulcers 
are circumscribed, and in the mouth, whether upon the 
inside of the lips, cheeks, gums, or tongue, they are 
always of a corroding and somewhat of a cancerous 
appearance. There is seldom at first more than one 
sore, which does not, however, continue long station- 
ary, for in this situation venereal sores extend quickly. 
Now 7 sores arising from mercury are always diffused, 
and we commonly find them in different parts of the 
mouth at the same time. Like the first appearance of 
the venereal ulcer in these parts, they are always su- 
perficial, but they have not that corroding aspect which 
the other assumes; and although foul and sloughy, 
their colour is materially different from those that are 
venereal. The latter are commonly of a dirty brown 
cohmr, in some instances with a slight tinge of yellow : 
v bereas the other has always a whitish appearance, as 
if the patient had newly been drinking milk. 

The situation of the sores also affords some means of 
distinction. Those arising from mercury seem to be 
induced chiefly by the pressure of the teeth and gums 
Upon those parts that are more particularly acted upon 



iH OF THE SYMPTOMS Ch. IV„ 

by the medicine ; so that we always find them where 
the swelling is greatest, and the pressure most consid- 
erable : Hence they are most frequent on the sides of 
the tongue, near to the angles of the jaw; and on the 
insides of the cheeks; and when they take place in one 
of these situations, we usually find them prevail over 
the others. Now the true venereal ulcer attacks one 
part just as readily as another ; seldom at first more 
than one part at once, and we find it just as frequent 
upon the upper part of the tongue, and on the under 
part of the mouth between the tongue and the teeth, 
where pressure has little or no influence, as in any oth- 
er part. 

\\ ith due attention to these appearances, and to the 
history of the case, no practitioner of observation will 
ever remain long in doubt ; but where any uncertainty 
takes place, the best method of removing it is to desist 
entirely from the use of mercury. If the sores are 
venereal they will soon become worse, if not, they 
will soon disappear when the swelling and tenderness 
induced by the mercury are gone. I think it proper, 
however, to remark, that sores of this kind do not al- 
ways heal as soon as might be expected. In some in- 
stances, the swelling of the mouth, produced by mer- 
cury, continues for a great length of time. I have 
known it in a very obvious manner more than two 
months after any mercury had been exhibited. In 
such cases, the sores procc eding from this cause do not 
readily heal; and where due weight is not allowed to 
this circumstance, more mercury is in such a situation 
very often given, by which the constitution is not only 
apt to be injured but the very sores for which the med- 
icine was prescribed are rendered worse. In some ca- 
ses this no doubt proceeds from inattention or want of 
experience on the part of the practitioner: but it also 
criginaies from the fear and anxiety of patients, who, 
doubting of the real nature of the sores, and dreading 
their influence upon the constitution, are often so im- 
patient, that in a concealed manner they persevere in 
the use of mercury long after they have been desired 
to lay it aside. 



•SeC II. OF LUES VENEREA. 49 

I have insisted the more upon this point from a very 
considerable number of cases having fallen within my 
own knowledge of the most distressful consequences 
being produced by measures of an opposite nature be- 
ing persevered in. 

Patients in general are so easilv alarmed with what- 
ever gives the least cause to suspect that the virus is 
not entirely removed, that even the most trifling cir- 
cumstances, when treated with inattention by practi- 
tioners, may be followed with very important conse- 
quences. A spoiled tooth with sharp ragged edges, is 
very apt to produce a sore upon that part of the cheek 
or tongue to which it is contiguous; and as it takes 
place in a slow imperceptible manner, without exciting 
pain, and produces a foul sore, somewhat resembling 
a venereal ulcer, if the real cause of it be not discov- 
ered and removed, very troublesome consequences are 
apt to ensue from it. From this cause alone I have 
known a patient put under a tedious course of mercu- 
ry, which, with very ordinary attention, might have 
been prevented ; for wherever an ulcer forms, either 
on the inside of the cheek, or on the tongue, the state 
of the contiguous teeth should be examined ; and 
where any spiculse, or inequalities are discovered, they 
should be completely removed, and due time allowed 
for the sores afterwards to heal, before any other meth- 
od of cure is recommended. 



The venereal oz&na or that ulceration and caries of the nose* 
which constitutes it, is sometimes so malignant in its nature and sq 
rapid in its progress, that the bones attacked are actually destroyed 
in some few instances as soon as the state of the case is clearly 
known, and in others* before the specific can be used with sufficient 
effect to check the disease. These therefore, of all cases require 
the most careful attention. 

Among the forerunners of this symptom, Mr. Howard mentions 
the following. When the os front.s, in consequence of a previous 
node, has become carious at its lower and middle part, just above 
the root of the nose and that caries is of considerable depth, through 
the outer table of the skull, the disease may insinuate itself thence* 
inwards, to the os ethmoides and bones of the nose, and precede an 
ozsena of the most alarming kind. Pains deep seated in the palate 
VOL. II. 7 



.^0 OF THE SYMPTOMS Cb.1T* 

or bones of the nose, more especially if they are felt towards its 
root, either tvith or without a purulent and foetid discharge, be it 
ever so trifling or small in quantity, when not the effect of catarrh, 
scrophula, or scurvy, are also circumstances extremely suspicious. 
As ozsena very seldom occurs without previous well marked venereal 
symptoms, it is particularly proper to attend to the history of the 
case. It must be carefully distinguished from the effects of bad 
teeth, from scurvy, scrophula and from that kind of abscess which 
sometimes forms in the Antrum Highmorianum. — The disease is 
often not confined to the nose, but extends to the palate, velum pen- 
dulum palati, tonsils, and pharynx, and generally the tone of the 
voice is materially altered. (Howard on the Venereal, Vol. 1. 
p. 113.) 

It is worthy of remark in this place that Mr. Pearson considers 
the ozaenato occur frequently as a symptom of Cachexia syphiloidea, 
or Pseudo syphilis. (See the Note on Diseases resembling Syphilis.) 

The posterior part of the oesophagus, the tongue, the cheeks, and 
the velum pendulum palati, are sometimes attacked with venereal 
ulceration, and they sometimes appear singly, without any other 
symptom of lues, but most frequently in combination. When lues 
venerea attacks the tongue, Mr. Hunter remarks that it will some- 
times produce a thickening and hardening of the part, but when 
there are sores they are generally more painful than those in the 
throat, and oblige the patient to speak thick. It is often difficult to 
discriminate a venereal ulceration of the tongue from a cancerous 
one. In this case Mr. Howard recommends a careful examination 
pf symptoms for years past, and a resort to mercury in al) cases, 
as a cancerous affection is incurable, and if the specific cause only 
aii amendment, the practitioner may in general be assured that the 
case is venereal. Em 

$ 6. Venereal Blotches. 

Nex^to the parts which we have mentioned, the mat- 
ter of Lues Venerea is most apt to fix upon the surface 
of the body in the form of eruptions, or what are com- 
monly termed blotches. In a few cases the skin is af- 
fected before either the throat, nose, or mouth ; but 
this is by no means frequent. 

Every part of the body is liable to these blotches, 
but they appear more frequently on some parts than on 
others. The cause of this is difficult to explain, for 
when the whole system is affected we cannot a priori 
say why one part should more readily be attacked than 
another, but there is no doubt of the fact. In account- 
ing for this disease fixing most frequently upon the 
throat, nose, and mouth/ some have ingeniously sug- 



SeC. II. OF LUES VENEREA, 51 

gested that there is probably some particular attraction 
between mucus and the matter of this disease, from 
t\ :ese parts being plentifully supplied with mucous 
glands: and mercury being particularly apt to affect 
these parts, while we know that mercury in every form 
very readily combines with mucus, a theory has been 
built upon this to account for the action of mercury 
in the cure of the disease. Admitting the opinion to 
be well founded, but which dots not appear to be the 
case, still it would not account for the matter of this 
disease heing particularly apt to fix upon the skin, pe- 
riosteum, and bones, parts which are less plentifully 
supplied with mucous glands than any others of the 
body. Neither does the idea hoid good here which 
we have already had occasion to notice, and which 
some have endeavoured to support, of the matter of 
this disease having a particular attraction for parts that 
are most exposed to the atmosphere. In the rise and 
progress of the venereal eruption the reverse of this 
a, pears to be the case. 

I have observed above, that every part of the body 
is liable to be attacked with these blotches; but »ve 
find from daily observation, that they appear both 
more frequently and more early in the disease, on such, 
parts as are kept well covered than on those that are 
not covered at all. We no doubt meet with them both 
on the face and hands ; but for one instance of this we 
have eight or ten of their appearing upon the breast 
and arms; and next to these, they attack in succession 
and with some regularity, the shoulders, thighs, legs, 
feet, and hands. Of these last the extremities of the 
toes are often the parts first affected, particularly the 
parts lying beneath and round the nails. 

Eruptions of this kind excite no pain : a slight de- 
gree of itchy uneasiness is the first sensation which 
they produce. When examined in this state, they are 
found to consist of a number of small distinct blotch- 
es, scarcely rising above the surface of the surround- 
ing parts, and seldom exceeding the size of a sixpence. 
They are of a pale red colour, and when smartly rub- 
bed the cuticle falls off in the form of fine bran, leav- 



52 OF THE SYMPTOMS Ch. IV. 

ing the skin beneath somewhat more deeply tinged 
with red. The skin, however, does not appear to be 
otherwise injured ; and when the blotches are allowed 
to disappear of themselves, as they commonly do, the 
skin is, for a considerable time, found to be perfectly 
sound, and not even altered in colour. 

But although eruptions of this kind disappear from 
time to time, no advantage is gained by this ; they ei- 
ther proceed from one part to another, or they attack 
the same parts with more violence. In returning upon 
parts where they have been before, the cuticle is more 
elevated from the skin beneath ; and on being remov- 
ed, the skin itself is found to be either somewhat in- 
flamed or in a state of tenderness approaching to. ulce- 
ration. The skin not being in a state fit for producing 
cuticle, a scab or crust now forms upon these tender 
parts. In the course of a few days matter forms be- 
neath, which for some time oozes out at the sides, till 
the crust separating and falling off, the foundation is 
thus formed of the true venereal ulcer, of which a 
description will afterwards be given. 

In some cases these red, or rather mottled blotches, 
instead of proceeding to a state of ulcer in the man- 
ner I have just described, are all covered over with an 
infinite number of very small pimples, each of which 
contains matter ; and from these running together, a 
crust is formed, which likewise falls off at last, and 
leaves the parts in a state of ulceration. 

When blotches take place among the hair, which 
they frequently do, as they do not in their first stage 
rise much above the level of the surrounding parts, 
and as they never in this state create much uneasiness, 
they are seldom perceived till a scab or crust begins 
to form, and as the matter on oozing out gets matted 
into flakes with the hair, we are longer in this situation 
than in other parts of the body, of getting a view of 
the parts beneath, which, on the crust falling off, are 
always in a state of ulceration, forming what is com- 
monly termed the corona veneris. 

In tue palms of the hands and soles of the feet the 
firmness of the skin prevents these blotches from ap? 



SeC. II. OF LUES VENEREA* 53 

pearing so obviously as in other parts. The cuticle 
is here either separated in broad flakes, early in the 
disease, or if it is so firm as to confine the matter for 
a considerable time, it at last bursts out, when the 
parts beneath are found to be ulcera* ^d. 

It is chiefly in this eruptive state of the disease that 
it attacks the nails of the fingers and toes. The cu- 
ticle which surrounds them is perceived to be red and 
tender; the parts below the nails also become red, and 
the nails at last become loose, and fall off*. 

The complaints most similar to venereal blotches, 
and with which they have frequently been confound- 
ed, are all the variety of herpetic eruptions, particu- 
larly such as are dry, and do not yield matter. There 
is one remarkable difference between them in the na- 
ture of the matter which they afford. The matter of 
the true venereal eruption is so tough and viscid that it 
does not crack, and commonly remains upon the parts 
perfectly entire, till it separates and comes away; 
whereas in herpes, although the matter is in one va- 
riety of the disease of a viscid glutinous nature, it does 
not form into flakes, as it very universally does in Lues 
Venerea. It sometimes forms into crusts, but these 
break and come away in small pieces. 

In herpes the eruption appears most frequently in 
the form of a circle and the pails which it surrounds 
appear to be sound : Hence by the common people it 
is usually termed ring-worm. These circles or rings 
are of every variety of size, but they are seldom less 
than a half-crown piece. Now the venereal blotch is 
not often larger than a sixpence, and never exceeds 
the size of a shilling ; and the whole skin of the parts 
affected appears to be nearly in an equal degree of 
disease. The mottled appearance which they assume 
gives cause indeed to suppose that some parts of the 
skin remain sound ; but on examination with a magni- 
fying glass, the whole is found to be more or /less dis- 
eased. Whereas in the herpes, the parts surrounded 
with the ring are equally sound with any part of the 
body. 



54 OF THE SYMPTOMS Ch. IV. 

In judging of this point we derive no small assist- 
ance from attending to the situation of the eruption, 
as well as from the history of its rise and progress. 
We have had occasion to observe that the venereal 
eruption appears most frequently at first upon the 
breast and arms. Indeed this very commonly hap- 
pens ; whereas in herpes it is most frequent upon 
the under part of the abdomen, and about the hands 
and wrists. 

When to all these circumstances we add, that in 
the venereal eruption there is commonly much cause 
for suspicion, from the patient's course of life, and 
perhaps even from the existence at the time of some 
other symptoms of the disease, and that in herpes 
we often find that the patient has either at some for- 
mer period been liable to eruptions of a similar na- 
ture, or that they have prevailed in his family, scarce- 
ly any cause for doubt will remain. 

Herpetic eruptions and venereal blotches sometimes 
occur in the same person at the same time. In this 
case it may be difficult, or perhaps impossible to dis- 
tinguish them ; but no great inconvenience can arise 
from this, for the existence of the venereal affection 
being ascertained, this, as being the most important of 
the two, must have the specific remedy employed for 
removing it, and if the other eruption continues after 
the venereal blotches are carried off, proper remedies 
must afterwards be employed for it. 

I know no other eruption that may not be easily 
distinguished from venereal blotches. 



In this symptom, there is commonly great variety. The venere- 
al blotches are sometimes copper coloured, and as they advance in 
age, contain diseased mucus or matter. On breaking, they assume 
the crusty honeycomb appearance described by Sydenham. Others 
are red and florid. Venereal Eruptions are generally preceded by 
pains and as there is a consent between the skin and the internal sur- 
faces of the body, if the eruption be small, the inclination to an af- 
fection of the periosteum will be great. (Howard on the Venereai.) 
Dr. Willan in his splendid work on Diseases of the skin, mentions 
a number of eruptive complaints which are venereal in their nature. 
They resemble the following genera, Lichen Lividus, Lepra Ni- 



Sec. II. OF LUES VENEREA. 5& 

gricans, Psoriasis Guttata, P. diffusa, P. Gyrata and Erythema pa- 
pu latum. For the diagnostick marks between the common and syphi- 
litic forms of these diseases, we refer to the above cited work. Most 
of the latter, it must be observed, will run into ulceration, if not 
prevented bv the administration of mercury. 

Ed. 

§ 7. Of Venereal Ulcers. 

In $ 2. of this section I have already given a de- 
scription of chancres, or ulcers produced by the local 
application of the venereal virus. It is those ulcers 
we are now to consider which take place, in more ad- 
vanced stages of the disease, and which evidently 
proceed from the virus having entered the system. 
In § 4. and 5. venereal ulcers of the throat, nose, and 
mouth, have been described, but ulcers from the 
same cause appear occasionally in almost every part of 
the body. 

But although no part of the body is perhaps entirely 
exempted from these ulcers, I mean no external part 
of it, yet some parts are much more liable to be at- 
tacked with them than others; and it is a fact worthy 
of remark, that there is no part of the surface of the 
body on which they do not occur more frequently 
than on the genitals. Indeed venereal ulcers of these 
parts, from infection of the constitution, is an occur- 
rence which seldom falls within our observation. Al- 
most every ulcer on the genitals may be traced to a 
local application of the virus. 

We have already had occasion to observe that ve- 
nereal blotches are apt to terminate in ulcers. Hence 
the venereal ulcer is most frequent on these parts that 
are attacked with these eruptions, particularly the 
breast, shoulders, and arms. We often meet with 
them among the hair, and between the fingers and toes. 
In the latter stages of the disease indeed, I have met 
with them more frequently upon the sides of the toes 
than on any other part. 

For the most part the venereal ulcer is preceded 
either by blotches, such as we have just described, or 
by a number of very small pimples ; but I have met 



56 OF THE SYMPTOMS Ch> IV* 

with some instances of a part becoming ulcerated 
without either of these appearances going before it* 
A slight degree of itchiness prevails for some days, 
and the part is scarcely observed to be discoloured be- 
fore an ulcer is perceived. 

In whatever manner a venereal ulcer may form, the 
appearances which it afterwards exhibits are nearly 
the same. A considerable destruction of parts soon 
takes place; more quickly indeed than usually hap- 
pens from any other cause except mortification. In- 
stead of proceeding gradually from the surface down- 
wards, as other ulcers do, a certain portion of the soft 
parts between the affected spot of the skin and bone 
beneath seem to be contaminated at once ; for almost 
as soon as the skin becomes evidently ulcerated, the 
corresponding parts beneath not only appear to be 
diseased, but are soon thrown so entirely out that 
scarcely any thing but the periosteum is left to cover 
the bone. 

The sides and bottom of venereal ulcers of every 
description are at first always foul; but while chancres 
and all recent ulcers are usually white and sloughy, 
sores proceeding from diseases of the constitution are 
of a dirty brown appearance. The matter which they 
discharge is sometimes thin, and so acrid as to destroy 
the contiguous parts, but for the most part it is more 
tough and adhesive than good pus. It has often a sin- 
gularly green colour, particularly in ulcers on that 
part of the head covered with hair, and it is always of 
a very disagreeable foetid smell. 

These ulcers are seldom accompanied with much 
pain ; for although the skin which surrounds them has 
always a tender appearance, being in almost every in- 
stance of an erysipelatous red colour, they can bear 
to he handled more easily than sores of any other 
kind of equal extent. The parts, in some cases indeed, 
seem to be deprived of their natural sensibility; and 
I have in such instances found that one of the first ef* 
fects of the mercury prescribed for the cure has been 
to render them more irritable. 



SeC. it. OF LUES VENEREA. >W 

Venereal ulcers arising from disease in the constitu- 
tion differ from all such as are local in our not being 
able to render them clean or bring them to a healing 
state by any external application that we can employ. 
Where any doubt exists of the cause, they are often 
treated with local remedies ; but no advantage is de- 
rived from them. Even the most powerful detergents 
have no influence. The parts still remain foul. The 
matter continues to increase in acrimony; and if a 
course of mercury is not prescribed, or if not given 
in sufficient quantity, the sores not only become more 
extensive, but more numerous, by parts taking on a 
disposition to ulcerate which did not previously bear 
any mark of disease. 

The description which I have given of the venereal 
ulcer comprehends all the ordinary appearances of 
these sores; but some difference is produced in them 
by a variety of causes; by the nature of the parts in 
which they are seated ; by the constitution being sound 
or affected with other diseases ; and by the effects of 
such remedies as may have been employed without 
being sufficiently powerful to accomplish a cure. 

In a great proportion of cases the venereal ulcer is 
seated in the skin and cellular membrane. In the first 
instance, indeed, these are the only parts that are af- 
fected; but in more advanced periods of the disease, 
we find the virus fixing upon the tendons, fasciae of 
the muscles, periosteum, and bones. The parts least 
liable to be attacked with it are the glands, particular- 
ly those of the lymphatic system, but occasionally 
even they are affected with it. JNow we may easily 
suppose, that the ordinary appearance of the disease, 
that which it exhibits when seated in the cellular sub- 
stance, will be materially different from that which 
takes place from it in the tendons, fasciae, glands, or 
bones. It is difficult, however, and perhaps impossi- 
ble, to give any adequate description of the different 
appearances which occur in these ulcers thus different- 
ly situated. It is from experience alone that a know- 
ledge of this can be obtained* 

The appearances of venereal ulcers are more or less 

VOL. II, 8 



58 OF THE SYMPTOMS Ch. TV. 

affected by 'every disease which the system may at the 
time labour under. Some indeed have contended that 
no two diseases can exist in the constitution at the same 
time. This remark, however, is certainly ill-founded, 
From daily observation, we find, not only that the 
system may be affected with different diseases at the 
same time, but that two diseases may at the same time 
fix upon the same part. Of the first we have instan- 
ces without end. It happens in the combination of 
fever with every variety of general cachexy, such as 
dropsy, jaundice, &c. of small-pox with scrophula, 
and scrophula with scurvy ; all of which are often met 
with, existing, and making progress in the same per- 
son at the same time, and of local complaints combin- 
ing in the same part, a variety of instances might also 
be mentioned. I have at present a person who had 
long been liable to piles, who some time ago was at- 
tacked with condylomatous excrescences about the 
anus from a venereal taint ; to these succeeded a com- 
mon abscess from inflammation, and last of all the 
parts have become cancerous. As all of these are ob- 
viously in existence at this moment upon the same 
parts, and as instances of other combinations of local 
diseases are occurring daily, it is with surprise and as- 
tonishment that I find much labour and ingenuity em- 
ployed to prove that this connection of diseases never 
takes place, and in a work too which does the highest 
credit to the author. 

The opinion which the author of that work endeav- 
ours to establish, is indeed so contrary to the observa- 
tion of all who have paid attention to the subject, that 
I should not have judged it necessary to take notice of 
it, were it not with a view of preventing the unexpe- 
rienced from being misled by it ; for were it to be re- 
ceived as a general principle, it would in a variety of 
circumstances have no small influence on practice, and 
would often, lam afraid, be productive of distress 
and disappointment, both to patients and practitioners.^ 

* The publication to \thich I allude is Mr. Hunter's Treatise on the Vene- 
real Disease. 



Sec. II. OF LUES VENEREA. 59 

If this opinion was well founded, every ulcer of the 
venereal kind arising from disease of the constitution 
should yield to mercury alone: Instead x>f which, do 
we not daily meet with sores of this kind, in which 
mercury by itself fails entirely, and in which, from 
ihe constitution being at the same time infected with 
scrophula, or some oiher disease, bark and other re- 
medies must be employed before any progress towards 
a cure can be obtained ? This combination of Lues 
Venerea with other diseases, particularly with scro- 
phula and scurvy, is indeed, I apprehend, the most 
frequent obstacle which we meet with in the cure of 
almost every symptom of this disease. Buboes, as 
well as ulcers, are always particularly obstinate where 
scrophula prevails; and the slightest tendency to scur- 
vy puts it out of our power to employ mercury in 
such quantities as the cure of venereal ulcers often 
requires. The effects of this are chiefly perceived at 
sea, where a patient with Lues Venerea is sure to have 
all the symptoms aggravated, particularly such ulcers 
as may prevail, on his being attacked v\ith scurvy. 
The ulcers not only put on a worse appearance, but 
till the scorbutic affection is removed, the farther use 
of mercury is for the most part laid aside. 

The description of the venereal ulcer which I have 
given above relates to the disease in its more early sta- 
ges, and where no mercury has been employed. When 
mercury is prescribed, and has entered the system, 
sores of this description soon put on a healing appear- 
ance '; and if the medicine be continued, the cure usu- 
ally goes on without interruption. But if, instead of 
being long enough persisted in, the mercury is laid 
aside before the virus is eradicated, an effect results 
from it which could not a priori be expected. This 
partial effect of mercury not only gives a different ap- 
pearance to venereal sores, but commonly renders 
them more obstinate. If the sores have healed, and 
again break out, although they will not go to such a 
depth as they did in the first process of ulceration, 
they will spread farther, and become more numerous, 
J3y this imperfect application of mercury, a disposi- 



60 OF THE SYMPTOMS Cll. IV, 

lion seems to be formed, not only in the parts contigu- 
ous to the old sores, but in almost all the soft parts of 
the body, to go readily into a state of ulceration ; and 
although the new sores which take place do not go 
deeper than the cellular membrane, they daily be- 
come more numerous, insomuch that the parts in which 
they are chiefly seated are apt to acquire a honey- 
comb appearance. 

But although these newly-formed ulcers seldom pen- 
etrate to such a depth as those to which they succeed- 
ed, they assume every other appearance of the true 
venereal ulcer. They are foul and somewhat spongy : 
They are not attended with much pain, and the sur- 
rounding skin has an erysipelatous, or copper-colour 
complexion. In the course of my experience, how- 
ever, they have always proved to be of more difficult 
management than the others; nor does mercury act 
with such certainty in removing them. The same 
sores either continue obstinately to resist the effect of 
this remedy, or, if these heal, others break out, and 
thus spread over a very considerable extent of sur- 
face, giving all the appearances of the phagedsenic or 
depascent ulcer of different authors. 

Hitherto I have been supposing that the disease is 
confined to the soft parts of the body ; but where the 
ulcers as now described, have been neglected, or where 
the remedies employed for removing them have not 
proved effectual, they are apt to affect both the bones 
and tendons; and where sores take place upon any of 
these parts, their appearances are materially different 
from the common venereal ulcer. The parts affected, 
instead of being corroded, and hollowed out in the 
form or a cup, as they usually are in the venereal ul- 
cer, are filled with a soft fungous substance, of an un- 
healthy complexion, which bleeds freely on being in- 
jured, and which always returns soon on being destroy- 
ed with escharotics. The discharge of these ulcers, 
"when seated upon carious bones, is thin and of a brown 
colour, and still more foetid than the ordinary discharge 
of venereal ulcers in the softer parts of the body. 
When the surface of a tendon becomes ulcerated the 



See. IT, OF LUES VENEREA. 61 

parts are not only soft and spongy, but more foul or 
sloughy than sores of almost any other kind. 

There is another variety of venereal ulcer of which 
it is proper to take notice, I mean that which succeeds 
to the bursting of a bubo. Seated in the body of a 
gland, this kind of sore has a very different appear- 
ance from the common venereal ulcer, which attacks, 
as we have just seen, the skin and cellular substance 
only. Buboes are always accompanied with pain and 
inflammation : Hence when matter forms in them, it is 
of the purulent kind. But although the common ve- 
nereal sore is always attended with some degree of red- 
ness, as this is not of the true inflammatory kind, be- 
ing evidently erysipelatous, and which we find from 
experience never produces purulent matter, the dis- 
charge accordingly is different. But although the 
matter of buboes is always more or less purulent at 
first, it usually becomes thin and acrid at last, owing 
to sores of this description, on the farther continuance 
of the disease, being apt to become erysipelatous. 
Besides this change which takes place in the nature of 
the matter, the parts in which it was collected, al- 
though at first they have all the appearances of a com- 
mon abscess, at last become foul and spongy ; the 
edges of the sore become callous; and a much greater 
degree of pain takes place than almost ever accompa- 
nies the ordinary form of the true venereal ulcer. 

But although the sore which succeeds to a bubo is 
necessarily at first always in the body of a gland, we 
find at last that it is apt to spread and affect the contig- 
uous parts. The matter pervading the cellular sub- 
stance, sinuses form ; and the skin becoming inflamed, 
the foundation is thus laid for the formation of other 
sores. In this manner the ulcers which succeed buboes 
frequently spread to a great extent, one part either 
breaking out as another heals, or perhaps the whole 
continuing open, so as to leave all the upper part of 
the thigh, and in some cases, the under part of the ab- 
domen, covered with small sores. 

No part of the treatment of Lues Venerea gives 
more distress to patients, or more perplexity to prac- 



62 OF THE SYMPTOMS 6h. IT. 

titioners, than the management of this ulcerated state 
of buboes, which, besides being accompanied with 
much pain, is often one of the most obstinate symp- 
toms of the disease. Instead of yielding to the use of 
mercury, sores of this description become often more 
obstinate after mercury has been employed ; fever is 
apt to take place ; and where the constitution is not 
very robust, they even sometimes end in the death of 
the patient. 

This great degree of inveteracy in these sores may 
originate from different causes; but I have commonly 
found that it takes place in scrophulous constitutions, 
and in such as are particularly delicate. It may also 
be remarked, that among our common people sores of 
this kind are still more particularly obstinate in such 
as are under the necessity of living in damp situations, 
as is usually the case with weavers. 



Venereal Ulcers are distinguished by their spreading irregularly, 
by sioughiness, and by the appearance of their edges, and when the 
true skin is affected, by their exquisite tenderness. (Howard.) In 
some cases it has occurred, that the ulcers are of a round shape, 
and M. Richerand mentions instances of this nature, which com- 
menced healing from the centre. It is problematical however 
whether these were really syphilitic. (Rees' Cyclopedia, Art. Lues 
Venerea.) Ed. 

J 8. O/ Nodes, and other Swellings of the Periosteum, 
Bones, and Tendons. 

A node is a hard circumscribed tumour, proceed- 
ing from a bone becoming affected with a venereal vi- 
rus. The periosteum, tendons, ligaments, and even 
fasciae of the muscles, are also liable to be attacked 
with the matter of this disease. 

The venereal virus, however, does not readily at- 
tack these harder parts of the body. In a great pro- 
portion of cases it remains long in the habit be tore 
tl ey become affected, and when tumours appear upon 
them, it is often at such a distant period from the ex- 
istence of any other symptom of Lues Venerea, that 



SeC. II. OF LUES VENEREA. 63 

both the patient and practitioner are apt to be deceiv- 
ed, and to conclude that they proceed from some other 
cause ; Hence pains and swellings occurring in this dis- 
ease are often treated as rheumatic affections, in con- 
sequence of which remedies are prescribed from which 
no advantage is derived ; while mercury, from which 
alone relief could be obtained, is entirely overlooked. 
But although the true venereal node never takes place 
early in the disease, I mean such swellings as are of 
an osseous nature, and originate from the bones, yet 
the periosteum and tendons, as well as the fasciae of 
muscles, are in some instances very early affected, 
This I have known to happen almost as soon as there 
was cause to suspect that the virus had entered the sys- 
tem. In such cases, however, some obvious reason 
could alwavs be given for this variation in the course 
of the disease, by which the virus was made to fix up- 
on these parts in preference to others, which usually 
are first affected. In all of them the patients were 
found to have been much exposed to the effects of cold 
and dampness, which I have had many opportunities 
of observing to have an evident influence in exciting 
the virus of this disease to fix early upon these parts. 
Soldiers infected with Lues Venerea, when exposed to 
the cold and dampness to which they are usually liable 
during encampments, are particularly apt to suffer 
with swellings of this kind. 

Although it is of much importance to distinguish be- 
tween such of these affections as arise from the bone, 
and those which proceed from the periosteum, tendons, 
and muscular fasciae, yet this has not commonly been 
done with sufficient accuracy. They have all been 
considered as nodes, and blended under one general 
description, by which a good deal of perplexity has 
been introduced in the method of cure. 

Nodes may appear upon every bone of the body, 
but they are most frequent where the bones are thinly 
covered with muscles: Hence they are most common- 
ly met with upon the forehead, upon the forepart of 
the tibia, and on some parts of the radius and ulna. 
We also meet with them on the bones of the hands and 



64 OF THE SYMPTOMS Gh. I\% 

feet. I never, however, saw them on the fingers of 
toes, but I have observed them upon the sternum and 
ribs. In two instances, where the patients died of oth- 
er diseases after being cured of Lues Venerea, and in 
whom severe pains had occurred in the middle of the 
thighs, nodes or exostoses upon the femur were dis- 
covered. In one there were two small knobs or pro- 
tuberances, in the other there were upwards of twen- 
ty, and all of them upon the anterior part of the bone. 

These osseous tumours do not produce any altera- 
tion in the colour of the skin, unless they arrive at a 
much larger size than is usual. Their first approach 
is distinguished by a slight degree of uneasiness in the 
parts affected. This excites the patient's attention, 
when on examination a small hard tubercle or protu- 
berance is discovered. This in a gradual manner be- 
comes larger ; and, while it increases in size, it also 
becomes more painful. By the time that it has acquir- 
ed the bulk of half an ordinary walnut, and few nodes 
I believe are ever larger than this, the skin has com- 
monly become red and tender: and ulceration at last, 
taking place, the bone on being thus denuded, is not 
only found to be swelled but completely carious. 

This is perhaps one of the most painful symptoms 
of Lues Venerea; for although the pain is at first al- 
ways moderate, it never fails to become severe on the 
tumour advancing in size. This does not. depend so 
much, however, on any alteration produced in the 
bone itself, as on the distension of the periosteum, 
•which the tumour of the bone necessarily occasions; a 
circumstance of which we are rendered certain by t he- 
pain ceasing entirely on the protuberance of the bone 
being laid bare, either by an incision, or by the soft 
parts which cover it being destroyed by ulceration. 

This description of a node, it is proper to remark, 
comprehends the full progress of this kind of tumour 
to its last and ultimate stage; a termination we seldom 
meet with, if it be not among the poor and destitute. 
Mercury is commonly prescribed as soon as the nature 
of the tumour becomes obvious, and as this puts a stop 
lo its farther increase, it is by great inattention or mis^ 



SeC. ife OF LUES VENEREA. 65 

management only that the surrounding soft parts are 
ever allowed to ulcerate. When ulceration does take 
place, the parts soon assume all the appearances of the 
true venereal ulcer of which we have already given a 
description. 

The same bones upon which nodes most frequently 
take place are liable to tumours of a different kind, 
which, from their bearing a resemblance to nodes, 
have improperly been distinguished by the same ap- 
pellation. By some, indeed, all tumours upon these 
parts, as well as such as occur in this disease upon the 
tendons, ligaments, and fasciae of the muscles, are con- 
sidered as nodes. This proceeds -from the confused 
manner in which these symptoms were described by 
the first authors who wrote upon this subject, by which 
others who have not paid particular attention to it have 
uniformly been misled. It requires, however, no nice 
discrimination to perceive that the tumours to which 
these parts are liable from Lues Venerea are material- 
ly different in their formation, and requiring also a 
difference of treatment, it becomes an object of no 
small importance to have this pointed out. 

The tumours which most resemble nod aie produ- 
ced by an effusion of a small quantity of matter be^ 
tween the periosteum and bone. This seems to pro- 
ceed from the internal surface of the periosteum be- 
coming slightly inflamed, by which a few drops of a 
colourless fluid are poured out upon the surface of the 
bone. If not prevented by an early exhibition of 
mercury, the tumour, which was at first so small as 
to be with difficulty perceived, becomes gradually 
larger, and from being hard and colourless, it becomes 
soft and inflamed. Even when of the greatest bulk, 
however, at which it commonly arrives, this tumour 
does not exceed the size of the real node ; for the pe- 
riosteum not being capable of much distension, it 
either soon bursts, or the tumour becoming very 
painful, relief is obtained by making an incision in- 
to it. 

These tumours, although at first always hard, are 
by no means so firm as nodes. This, even in their 

VOL. IIv 9 



&X OF THE SYMPTOMS Cll. IT. 

commencement, serves as a sufficient mark of dis- 
tinction between them ; and where matter is formed, 
as the tumour is thinly covered, a fluctuation is soon 
perceived, by which in the progress of the complaint, 
It is clearly and evidently distinguished from nodes, 
which always remain hard to the last. 

When tumours of this description either burst ov 
are laid open, all hough the bone may be found to be 
rough and carious, no swelling is discovered ; and on 
the ulcer healing by the means to be hereafter men- 
tioned, the parts appear to be reduced to the level of 
the surrounding skin ; whereas in real nodes, the tu- 
mour of the bone remains nearly, or perhaps entirely 
of the same size during the life of the patient, nor has 
mercury or any external application, any effect in re- 
ducing it. Some indeed entertain a different opinion, 
but where venereal tumours upon the bones have 
been removed by mercury, I have much reason to 
think that they have not been real nodes, but merely 
those small tumours produced by effusion which we 
have just been considering. At least this happened 
in different cases in which I have been concerned, 
where tumours, which at first were supposed to be 
formed of bone, appeared afterwards to proceed en- 
tirely from effusion ; and I have not met with a single 
Instance of a tumour evidently osseous being ever car- 
ried off by mercury, or any other medicine. 

Besides the tumours we have described, there is still 
another, by some also improperly termed a node, with 
which the parts covering the hard bones are not un fre- 
quently attacked in Lues Venerea. This variety of 
tumour occurs more early in the disease than nodes, 
and proceeds most frequently as I have observed 
above* from exposure to cold and dampness. It is 
also distinguished from nodes from its taking place in 
various parts of the body at once. 

The patient at first complains of pains over the 
whole affected limbs ; but he soon finds that one part 
of each limb is more severely affected than the resi- 
le the legs this happens about the middle of the tibia 
and fibula. In the thighs it occurs at the middle of 



Sec. II. OF LUES VENEREA. 67 

the femur, and in the arms along the whole course of 
the radius and ulna. 

For the most part these pains are considered by the 
patient as rheumatic ; and I have known many instan- 
ces, even of practitioners being deceived with them. 
No advantage, however, is obtained from those medi- 
cines which usually give relief in rheumatism ; and at 
last the parts from whence the pains chiefly proceed 
are found to be swelled. But this swelling is very dif- 
ferent from that fulness of parts which occurs in rheu- 
matism ; and it differs materially from the latter in the 
parts which it attacks. The rheumatic swelling is 
chiefly confined to the joints. In verv severe cases it 
no doubt stretches over every part of a limb, but it 
very commonly originates in the joints : Whereas 
those venereal swellings, although they sometimes 
stretch towards the joints, very universally fix up- 
on those parts of the limb that lie between one joint 
and another. In rheumatism the whole circumference 
of the limb becomes swelled in nearly an equal de- 
gree, while in the other the tumour is circumscribed, 
being most frequently confined to less than one half 
of the circumference of the limb ; or when one limb 
is affected in different parts, as often happens in the 
fore-arm between the elbow and wrist, the seat of each 
tumour can be very distinctly traced. In the venereal 
svselling of these parts the tumour is firm, and so deep- 
ly seated that on a slight examination it is often sup- 
posed to proceed from the* bone itself while that swel- 
ling which takes place in rheumatism is of a more 
compressible nature, and appears even on the slight- 
est examination to be altogether free from the bone 
beneath. 

By attention to these circumstances, as well as from 
the history of the case, we need never be under much 
difficulty in judging of the nature of these swellings, 
nor in determining when they are venereal and when 
of a rheumatic nature. It is a prevailing opinion, that 
the difference between them is sufficiently marked by 
the pain in all venereal affections of this kind being 
particularly severe when the patient is warm in bed,, 



68 OF THE SYMPTOMS Ch, IV. 

while the contrary is supposed to happen in rheuma- 
tism. I have not found, however, that any depend- 
ence can be placed upon this ; for both are apt to be 
very differently affected by the same cause in differ- 
ent patients, and even in the same patients at different 
times. 

This variety of swelling seems always to originate in 
the periosteum, and to proceed from some degree 
of inflammation, which first begins in that membrane 
and proceeds from it to the surrounding parts. Like 
every inflammatory affection of membranous parts, it- 
does not readily terminate in suppuration. I have 
never known an instance of matter forming in it : Nor 
do those serous effusions take place here which are so 
frequent in rheumatism; a circumstance which consti- 
tutes another characteristic distinction between the two 
diseases ; for rheumatism seldom arrives at a great 
height without swellings taking place in the parts 
chiefly affected, and they seem all to be of the serous 
kind. 

Almost every author who has written upon Lues 
Venerea describes affections of the ligaments, tendons, 
and fasciae of muscles, as frequent symptoms : This 
however, is far from being consistent with my expe- 
rience ; nor do I suppose that they often take place but 
in the most advanced stages of the disease. 

My own observation having led to this conclusion, 
I was induced to converse and correspond upon the 
subject with others, who from having much employ- 
ment in this branch of practice I had reason to sup- 
pose would be able to give me the best account of it. 
The prepossession which they had received from books 
had prevented them from entertaining a doubt of the 
frequency of this symptom, but none of them bad 
seen it so often as to be able from his own observation 
to give a distinct or well-marked account of it. 

Venereal ulcers often penetrate to ligaments, ten- 
dons, and other deep seated parts. In this manner 
every practitioner must have seen those parts affected 
with the virus of this disease; but in these the disease 
■uniformly begins in the skin, and proceeds to the parts 



SeC. II. -OF LUES VENEREA. 69 

beneath. Of swellings in the ligaments, tendons, or 
fasciae of muscles from this cause, I have met with 
very few instances ; and even of these some were of a 
doubtful nature, as they occurred in scrophulous con- 
stitutions. 

Those swellings, so far as I have had opportunities 
of observing, are not so painful as tumours of the pe- 
riosteum and bones. They are small and circumscri- 
bed: At first hard and colourless, and afterwards on 
the skin becoming red, they turn soft, and soon 
burst. The matter which they discharge perhaps nev- 
er partakes of purulency : It is thin, and either nearly 
colourless or somewhat tinged with blood. The sores 
which ensue are foul, and usually more difficult of 
cure than any other that we meet with in this dis- 
ease. 

I have seen different cases of tumours of a consid- 
erable size, seated upon tendons as well as upon apo- 
neurotic expansions, and which were suspected to be 
venereal. These have commonly been hard, and where 
they have come to create much uneasiness I have had 
occasion, in some instances, to remove them with the 
scalpel. Two of these were upon the tendinous part 
of the biceps ; and although in both they had been 
suspected to be venereal, a very decisive proof was 
obtained of the contrary, for the}' were both extirpa- 
ted, and the sores healed easily without any mercury 
being given. 



The soft tumours of which Mr. Bell speaks, commence with pain 
throughout the whole extent of cylindrical bones, bounded only by 
the epiphysis, and are succeeded by great tenderness, and unless 
mercury be speedily given, by a puffiness of the periosteum, re- 
taining the impression of the finger. This variety of node is called 
gummatous or soft in distinction of the other stiled tophaceous or 
hard. The latter is most common. That elevation of the bone 
which not unfrequently follows a venereal affection of the perioste- 
um, is named Exostosis, and the tumours which arise on muscles 
and aponeurotic expansions are often stiled Gummata, (Howard 
on the Venereal. En. 



70 OF THE SYMPTOMS 6h. IV. 

$ 9. Of Venereal Excrescences about the Anus. 

The parts of generation in both sexes are liable lo 
be attacked with warty excrescences in Gonorrhoea, 
most frequently towards the end of the disease, when 
the running is nearly gone. In some cases they spiead 
over all the contiguous parts, and even reach to the 
anus; but however extensively this may happen, ex- 
crescences of this warty nature which occur from Go- 
norrhoea are always local, as we judge from mercury 
having no influence in removing them, and from find- 
ing that topical remedies are alone to be depended up- 
on for a cure.* 

But besides these, the parts about the anus are occa- 
sionally attacked with excrescences truly venereal, 
which appear in the latter stages of syphilis only, and 
of which we cannot accomplish a cure by any remedy 
that is not conjoined with a complete course of mercu- 
ry. They are easily removed, either with the scalpel 
or escharotics; but if mercury is not administered 
they soon return with more virulence than at first. 

In some cases they appear at the same time with ve- 
nereal blotches in other parts of the body, which in 
many instances they resemble, being raised or elevated 
above the contiguous surface. Till of late I had not 
seen them but as a symptom of sibbens, and I did not 
suppose that they took place in the ordinary form of 
Lues Venerea. I have now, however, met with a suf- 
ficient number of instances to convince me that in this 
I was mistaken, and which shew that they not only oc- 
cur along with eruptions in other parts of the body, 
but that altogether independent of these they appear 
as a distinct symptom in still more advanced periods of 
the disease. 

They are not so hard as those warts which succeed 
to Gonorrhoea ; they are more of a fleshy nature, more 
tender, and therefore more apt to bleed. They have 
a more uniform surface ; and instead of being formed 
of a number of small warts connected together, a^ 

* See Vol. I. chapter II. Section 13. 



Sec. 21. OF LUES VENEREA. 71 

these tumours about the anus produced l>y Gonorrhoea 
usually are, we find them composed of one uniform 
mass. 

They do not approach so near to the verge of the 
anus as warty excrescences commonly do, being for 
the most part of the greatest extent and most elevated 
near to the tuberosity of the ischium. In some cases 
they become ulcerated, and discharge a great deal of 
very offensive matter; and when this happens in wo- 
men they appear sometimes to be productive of bu- 
boes; at least in different cases where buboes occurred 
in women, no other source of infection could be per- 
ceived. Why they should not be the cause of buboes 
in men may be difficult to explain; but although I 
have often met with them in men in a state of obvious 
ulceration, I never knew buboes to be the consequence 
of them. Perhaps in men the lymphatic vessels of 
these parts do not pass through any external conglo- 
bate glands, and if this is the case they cannot produce 
buboes; for in the history of buboes we have seen that 
tire matter of Lues Venerea does not excite swelling 
or obstruction in any of the internal glands. 

For the most part any ulceration which takes place 
in these excrescences is very superficial, and does not 
reach beneath the surface. In some instances, howev- 
er, sinuses form in them. In this manner I once knew 
a fistula in ano produced, for which it was necessary 
to perform the usual operation after the patient was 
cured of Lues Venerea. 

Like other symptoms of syphilis these excrescences 
eitl er" continue nearly in the same state, or become 
gradually worse, as long as no remedy is employed 
for the cure of the disease in the constitution. They 
never disappear either entirely or in part by any effort 
of the system; but if by a partial course of mercury 
their progress is interrupted, although the virus of the 
disease is not completely extinguished, they soon be- 
come less active than they were before ; in course of 
time they disappear altogether, and with whatever vio- 
lence the disease may break out in other parts of the 
body, it does not again excite a recurrence of excres- 



72 OF THE SYMPTOMS Cb. IV. 

cences. In the latter stages of Lues Venerea, when 
by a long continuance of the disease the whole system 
may be supposed to be contaminated, we find a varie- 
ty of symptoms existing at the same time; otherwise 
this, as we have already had occasion to observe, does 
not readily happen; nor do we commonly find early 
in the disease more than one or two of the symptoms 
subsisting at once. 



The warty excrescences mentioned above, may originate, ac-* 
cording to Dr. Adams from a secondary ulcer seated in those parts, 
and which having no power to heal itself, will assume this character 
from the nature of the parts. Mr. Hunter and Dr. Adams do not 
consider this symptom as really syphilitic, except in the instance 
stated above. 

Verrucae or warts on the parts of generation are not an uncommon 
appearance during the progress of the disease, particularly when 
chancres have been imperfectly cured. They are stated to be vene- 
real, when large, irregular in figure and numerous. It is doubted 
however by many, whether any description are really venereal ; if 
so they will yield to the general remedy. 

Ed. 

i 10. Of Swellings of the Testes. 

Inflammation communicated along the urethra in Go- 
norrhoea is the most frequent cause of swelling of the 
testes. This has induced many to suppose, and some 
to assert, that this symptom is never induced by Lues 
Venerea ; that it is always a local affection, and never 
produced by any disease of the constitution. 

That this is very generally the case I will readily ad- 
mit ; for in a great proportion of cases we can clearly 
trace the disease to a local cause, and it is most easily 
removed by local applications ; but this is not always 
the case, for I have met with various well-marked in- 
stances of the testes swelling from disease of the sys- 
tem alone. Those who doubt the fact will ask, In what 
manner can this be ascertained ? By the swelling com- 
ing on without any external injury ; by no Gonorrhoea 
having preceded ; by the patient being known to be 
infected with Lues Venerea at the time ; and by the 



SeC. II. OF LUES VENEREA. 73 

swelling being with ease and certainty removed by 
mercury, while it had daily become worse as long as 
those remedies were employed which usually prove 
effectual in swelling of the testes arising from Gonor- 
rhoea. 

With m^ these circumstances afford complete con- 
viction, and as I have repeatedly met with them I judge 
the fact to be clearly established. 

The very first approach of this swelling exhibits a 
difference between it and that which proceeds from 
Gonorrhoea. In this last a considerable degree of 
pain prevails from the first, and the disease begins in 
the epidydimis ; but in the swelling from Lues Venerea 
the patient for a considerable time feels only a slight 
uneasiness, and even on the farther progress of the dis- 
ease any pain that takes place is not acute, but dull 
and obtuse, such as might be supposed to proceed 
chiefly from the additional bulk and weight of the 
testes. The body of the testicle is always first affect- 
ed ; and it is only where the disease is neglected, or 
where the nature of it is mistaken, and mercury judg- 
ed to be improper, that the swelling proceeds to the 
epidydimis. 

These circumstances of themselves might sufficient- 
ly distinguish the one variety of swelling from the oth- 
er ; but we also observe that in the swelling from Go- 
norrhoea the scrotum becomes red and painful very 
early in the disease, by the inflammation spreading 
from the testicle ; whereas in the other the scrotum is 
very seldom affected, and in no instance till the swel- 
ling has been of long duration. Hence in the one the 
patient can scarcely admit of the parts being touched, 
while in the other little or no pain is produced, even 
when handled with freedom. In the hernia humoralis, 
as it is termed, the whole contiguous parts seem often 
to sympathise with the disease in the testis, by the pain 
spreading along the groins, and over all the upper part 
of the thighs and abdomen ; while in the other any 
uneasiness which occurs is either confined entirely to 
the testicle or to the course of the spermatic cord. In 
this the swelling comes slowly and gradually to «| 

VOL. II, 10 



74 OP THE SYMPTOMS gll. IV. 

larger size, insomuch that some weeks will pass before 
it arrives near to its height ; while in the other the 
tumour is often as large in the course of forty-eight 
hours as it ever becomes. 

Those who doubt of the existence of the swelled 
testes from Lues Venerea assert, that where the testi- 
cle becomes hard and enlarged, where no external vio- 
lence has been applied to it, and without being prece- 
ded by Gonorrhoea, that, the disease is always to be 
considered as of the true scirrhous kind, forming what 
in general is called sarcocele. This, however, is by 
no means the case, and the means of distinguishing 
between sarcocele and the true venereal swelling of the 
testicle are numerous and obvious. In the former the 
testicle has a considerable degree of hardness from 
the first. The patient is from the first commencement 
of the disease, distressed with sharp stinging pains 
through the body of the tumour, and by degrees these 
become as severe as they usually are in any case of 
cancer. The swelling, although at first smooth, soon 
becomes knotty and unequal, and at last it very con- 
stantly attacks the spermatic cord, which also becomes 
hard, knotty, and painful. Now, in a swelled testis 
from Lues Venerea, although a considerable degree 
of firmness takes place, it is by no means of that hard 
nature which always accompanies the scirrhous. We 
meet with no stinging pains, not even in the most ad T 
vanced stages of the disease. The swelling never be- 
comes hard and knotty, but retains a smooth, equal 
surface, and we meet with few instances of its proceed- 
ing to the spermatic cord. 

Tn addition to the description which I have given of 
the disease I may remark, that in its more advanced 
stages this swelling sometimes suppurates, and dis- 
charges purulent matter ; while in sarcocele, whenever 
the tumour bursts, it yields nothing but a thin, bloody 
sanies, as commonly happens in all cases of cancen 
The sores which ensue to the bursting of these tu- 
mours are fully as different in their appearances as the 
tumours are different by which they were produced* 
In the sarcocele the edges of the sore are hard and re- 
torted, accompanied with every other circumstance 



Sec. ir. of lues venerea. 7s 

that usually takes place in cancer; whereas in the ve- 
nereal swelled testicle, although the edges of the sore 
are hard, they are neither raised nor retorted, and the 
sore, while it is foul and sloughy, as venereal sores al- 
ways are, exhibits no appearances of cancer. 

In very advanced slates of this disease we sometimes 
find it accompanied with effusions into the tunica vagi- 
nal is testis, producing what may be termed a compli- 
cated hydrocele. This, however, is a circumstance 
equally common to every tumour of the same magni- 
tude and duration to which the testicle is liable. It 
even sometimes succeeds to the hernia humoralis, but 
not so frequently as to swellings of greater perma- 
nency. 

If this affection of the testes is neither uncommon 
nor difficult to distinguish, it may be said that the 
particular description which is here given of it is un- 
necessary ; and I should have judged it to be so, if in 
some late publications a contrary opinion had not been 
strongly inculcated. Even this would not have been 
a sufficient reason for dwelling long upon any point of 
little importance, but in the subject we are now con- 
sidering many circumstances are involved. Any theo- 
ry we can establish of the nature of the venereal poi- 
son, and of the means employed for removing it from 
the constitution, is in some measure connected with it; 
while, at the same time, it is obviously a point of real 
importance in practice. 



The symptom noticed above, is mentioned both by Pott and How- 
ard under the name of Venereal Sarcocele. The former surgeon 
however expressly remarks that it has neither the inequality nor 
the darting pains of the scirrhus, and both observe that the exhibit 
tion of mercury is the surest mode of discovering its nature. It 
is usually accompanied with other secondary symptoms. 

Er. 

§ 11. Of Alopecia. 

The disease termed Alopecia by Nosologisfs, or 
falling off of the hair, may be produced by different 



76 OF THE SYMPTOMS Ch. IV. 

causes ; but it is most frequently met with as a symp- 
tom of Lues Venerea in the more advanced stages of 
the disease. 

The hair of the head first separates in greater quan- 
tities than usual on being combed. The eye-brows 
become more thinly covered, and if a stop be not put 
to the disease of the constitution, all the hair of the 
bead, as well as of the other parts of the body, soon 
falls off. 

Before the hair begins to separate, a scurf is usual- 
ly perceived among the roots of it, which comes away 
in great quantities on the head being combed, com- 
monly in the form of fine bran. On this scurf being 
removed, the skin beneath has a red complexion ; but 
the patient does not complain either of pain or tender- 
ness, and the same kind of brany powder forms re* 
peatediv on the same parts, although carefully remov- 
ed from day to day. 

In some instances the hair is renewed in as great 
quantity as at first ; but this is not a frequent occur- 
rence : It only happens during youth, and where the 
vims of the disease is quickly and completely eradi- 
cated. In more advanced periods of life it always re- 
mains thin, not only upon the head, but on the eye- 
brows; and when the eye-lashes fall out from this 
cause they very seldom return. 

As mercury has commonly been given before the 
hair begins to separate, and often in considerable quan- 
tities, this symptom has by some been supposed to be 
more the effect of the medicine than of the disease,, 
This, however, has not been the result of my observa- 
tion. I have seen different instances of the hair drop- 
ping off in Lues Venerea, where no mercury had been 
employed ; and were it to be produced by mercury, 
it would necessarily occur more frequently, and it 
would happen with equal readiness in every disease 
for which mercury should be prescribed. 

1 consider it to be in almost every instance the effect 
of that scurf which in Lues Venerea sometimes forms 
among the roots of the hair. The matier by which 
the scurf is produced getting access to the roots, soon 
cuts off their connection with the surrounding parts, 



S-eC. II, OF LUES VENEREA, 77 

$ 12. Of Blindness as a Symptom of Lues Venerea. 

In the first chapter of this work some account is 
given of blindness produced by the retropulsion of the 
r. <alter of Gonorrhoea. But blindness which takes 
place in Lues Venerea is materially different both in 
i? s rise and progress, and in the remedies by which it 
is with most certainty removed. K 

Blindness from Gonorrhoea is always accompanied 
with much pain. A great degree of irritability, along 
with a plentiful discharge of matter from the eyes, and 
more or less inflammation, are the first symptoms of 
the disease. But in Lues Venerea, loss of vision, tc* 
a considerable extent, has commonly taken place long 
before much pain is experienced ; and if inflammation, 
ever occurs, it is not in any remarkable degree. 

The matter of Lues Venerea acts in different ways 
in producing blindness. One of the most frequent 
seems to be by injuring the optic nerves, whether by- 
acting immediately upon the nerve itself, or by first 
excising effusion, or the formation of tumours in the 
contiguous parts, by which compression of the nerve 
is at last produced.. 

It is in this manner I conceive that gutta serena takes 
place in the latter stages of Lues Venerea. In some 
cases it comes on in a gradual manner. The sight be- 
comes less perfect from day to day ; and both the pa- 
tient and his friends are surprized that this should hap- 
pen while the external appearance of the eye is not 
affected. But for the most part the disease takes place 
almost instantaneously, the patient being entirely de- 
prived of vision in the course of a minute or two from 
the time that his eyes became uneasy. Still the exter- 
nal parts of the eyes remain sound, but the pupils are 
always greatly dilated, and incapable of any degree 
of contraction, even when exposed to the strongest 
light. 

In some cases only one eye is affected, but for the 
most part the disease attacks both at the same time. 

Cataracts sometimes form from this cause. I have 
met with different instances of this disease in the latter 



78 OF THE SYMPTOMS Ch. IV, 

stages of Lues Venerea, where no other cause could 
be assigned for it ; and I conclude that it was the ef- 
fect of the venereal poison, from the peculiar manner 
of its approach. The lens is at first only partially af- 
fected, white streaks appear upon different parts of it, 
which extend by degrees, so as to produce opacity 
over the whole of it. 

Bfat the most frequent effect of the venereal virus 
upon the eye appears upon the vitreous and aqueous 
humours, and on the lucid part of the cornea. In 
some cases these humours are deprived of tlreir natu- 
ral transparency, they become somewhat milky, and 
at last completely opake. At other times this is evi- 
dently connected with an opake state of the lucid cor- 
nea, which becomes white and thickened, and in some 
instances so prominent as to disfigure the whole glohe 
of the eye. When this diseased state of the coats of 
the eye, ar.d of the humours which they contain occur 
at the same time, the whole body of the eye affords 
the appearance of one confused mass. Neither the 
chrystalline lens, nor' any particular part of the eye 
can be distinguished. 

Before this opacity takes place in the cornea, a num- 
ber of obstructed vessels are perceived on it, accom- 
panied with some degree of tenderness on being expos- 
ed to light : This gives cause to suppose that inflam- 
mation is about to occur; but the disease in this form 
makes no farther progress. The cornea in some spots 
becomes while and opake, probably by the effusion of 
part of the contents of these turgid vessels; but all 
this takes place with little or no pain, and without any 
of the ordinary concomitants of inflammation. Nei- 
ther does this whiteness of the cornea terminate in sup- 
puration, as opacity of this membrane produced by in- 
flammation is apt to do. It becomes even more white 
than the tunica albuginea itself, and evidently more 
thickened, but I never saw matter form in it. 

In some cases the venereal virus fixes upon the eye- 
lids, and chiefly upon their cartilaginous borders* 
This sometimes happens by itself, but for the most part 
it is connected with syphilitic eruptions in other parte 



SeC. II. OF LUES VENEREA. 79 

of the body. The parts become red and somewhat 
tender, and an effusion takes place among the eye-lash- 
es, either in the form of a dry scurf, or of a gummy 
viscid matter. In this latter state this effusion proves 
always very troublesome, particularly after sleep, as 
it glues the eye-lids so firmly together as to render it 
difficult, and even painful to open them. 

In this affection of the eye-lids, I have in different 
instances, observed a symptom which has not, so far 
as I remember, been remarked by authors. The tears 
at first, form in drops near the internal angle of the eye, 
and this terminates in a constant trickling over the 
cheeks. Those who are not accustomed to examine 
the eyes in this state are apt to consider this flow of 
tears as the commencement of fistula lachrymalis, 
whereas it proceeds from a cause which must effectu- 
ally prevent the formation of this disease. On minute 
inspection, it appears evidently to arise from the punc- 
ta lachrymalia being obstructed by the viscid matter 
forming upon the cartilages of the eye-lids, by which 
the tears which should pass by these openings into the 
lachrymal sac, and from thence into the nose, are ne- 
cessarily forced over the cheeks. In some cases this 
weeping state of the eyes proves to be temporary, and 
disappears with the cause by which it was produced; 
but in others it continues permanent, owing, I sup- 
pose, to the puncta being obliterated by the long con- 
tinuance of the disease. 

This constant flow of tears over the eye-lids proves 
always troublesome, and in some cases even painful, 
by exciting tenderness, and occasionally some degree 
of ulceration of the cheeks. 



The commencement of Venereal Ophthalmia, may be known ac- 
cording to Mr. Howard, by a peculiar fulness, redness and slight 
turgescence of the vessels of the tunica conjunctiva and cornea, 
with a want of lustre and clearness in the latter. It is sometimes,, 
lie observes, so painful as not to bear the stimulus of light, but most 
frequently otherwise, and this last, is the most dangerous, as it may- 
cause the patient to be inattentive. Unless the inflammation be ear- 
ly removed, an incurable blindness will follow. — In Venereal Oph- 
ihalmia., there is constantly present an irksome sense of itching. 



BO OF THE SYMPTOMS CI). IV. 

which is most troublesome towards evening, but both it and the pain 
remit in the morning, and this morning remission is considered by 
Plenck as a diagnostic mark of the presence of Lues. (Edmonston 
on Ophthalmia, p. 143.) In the more advanced stages of this disease, 
besides the effects produced on the humours of the eye, the hairs 
drop off from the cilia, the iris is changed in colour and the pupil 
acquires a ragged unequal appearance. 

Venereal Ophthalmia may be distinguished from the scrophulous, 
by the want of that inflamed appearance of the ciliary glands, which, 
often attends the latter, by the absence of scrophulous symptoms 
and by its having been preceded by other syphilitic appearances. 
(Howard.) Ed. 

$ 13. Of Deafness from Lues Venerea. 

When treating of the venereal sore throat in § 4. of 
this section, we had occasion to remark that a certain 
degree of deafness is, in some cases, a consequence of 
that symptom, the end of the Eustachian tube, when 
it terminates in the throat, being obstructed. The ef- 
fect resulting from this being in some instances consid- 
erable, we are led to suppose that this passage to the 
ear is of no small importance to the sense of hear- 
ing: I have known a very distressful degree of deaf- 
ness produced by it. 

Besides this, the venereal disease in some instances 
excites deafness by fixing upon the ear itself. The 
l)ones seem to be most liable to be attacked with it. 
When this takes place the patient is at first seized with 
a partial loss of hearing. This is succeeded by a dis- 
charge of foetid ill-coloured matter ; and in some cases 
the hones themselves come away. I need scarcely ob- 
serve, that a total and permanent loss of hearing en- 
sues. 

Where venereal blotches prevail universally over 
the body, and have been of long duration, they some- 
limes fix upon the ear, chiefly upon the lap of the ear. 
In some cases I have known them to affect the meatus 
externus so as to induce to a temporary deafness. In 
this event the passage is either stuffed with a dry scur- 
fy matter, or the lining membrane of the passage be- 
comes thickened, and occasionally tender and ulcera- 
ted, If this proceeds no farther into the ear a recove- 



SeC. II. OF LUES "VENEREA. 81 

ry may still take place ; but as the same kind of ten- 
derness is apt to attack the tympanum, deafness even 
from this cause often proves permanent. 

$ 14. Of Anomalous Symptoms. 

Besides the symptoms of which we have given a de- 
scription, there are others which from their appearing 
with less regularity may be termed anomalous. But 
these, although they occur occasionally^ every stage 
of the disease, prevail with most frequency when the 
infection has been of long duration. 

The most troublesome of these symptoms are chops, 
or clefts in the palms of the hands and soles of the feet. 
A red somewhat purple-coloured eruption appears up- 
on the skin of these parts. The cuticle separates and 
copes away. Still the skin remains discoloured; and 
at last chops form in different parts of it. They gen- 
erally remain dry, but in some instances they dis- 
charge a thin acrid matter. They are seldom painful ; 
but they are always obstinate and difficult to cure; 
and the cuticle is in some cases so completely remov- 
ed, that by the tenderness which succeeds to this the 
patient is for a considerable time deprived of the use 
both of his hands and feet. 

In some a disposition is formed in the skin and cel- 
lular substance of different parts of the body to be- 
e thick, rough, and unequal, producing what by 
INosologists is termed elephantiasis, or at least an af- 
fection which very much resembles that disease. In 
most instances where this has occurred, different parts 
of the body have been affected with it at once; but in 
others I have known it confined to one of the extrem- 
ities. In the slighter degrees of this affection the in- 
convenience produced by it is inconsiderable, and it is 
seldom accompanied with much pain; but where the 
limbs swell so much as they sometimes do, the distress 
Vyhich it excites is necessarily severe. A limb which 
swells from this cause becomes first very un wieldly; 
and on the swelling increasing, it at last bursts into 

VOL.il. 11 



82 OF THE SYMPTOMS Ch. IV. 

sores, which discharge a thin acrid matter, are always 
foul, and very seldom heal. 

I have met with different instances of this thicken- 
ing of the teguments in the scrotum. The skin retains 
its natural colour; but it becomes firm, and so much 
thickened as to form a tumour which in some cases ac- 
quires a very considerable bulk. All of them that 
have fallen within my observation came from warmer 
climates and tw r o of them were in negroes. They had 
been mistaken both for hydrocele and hernia, but I 
found in all of them that the tumour was produced en- 
tirely by a thickened state of the scrotum. 

From a hernia in the scrotum they are distinguished 
by the spermatic cord being entirely free of swelling; 
by the absence of all the symptoms of hernia; and by 
the swelling being much more firm than it ever is in 
hernia The same degree of firmness serves to distin- 
guish it from hydrocele, for no impression is made up- 
on it by pressure; and it is farther distinguished from 
it by its weight, being much heavier than any tumour 
of equal magnitude containing a fluid. 

This swelling of the scrotum bears a greater resem- 
blance to sarcocele, or a scirrhous testicle, than to any 
other affection of these parts. It is chiefly distinguish- 
ed from sarcocele by being totally free of pain, and 
from being of an equal smooth surface. The other is 
not only accompanied with pain, but the swelling is 
knotty and unequal. 

As the sores which occur upon these tumours are ve- 
ry apt to assume a cancerous appearance, and ulcers 
of a similar aspect being sometimes observed to suc- 
ceed to buboes, some have been thereby induced to 
consider cancer as a symptom of this disease. That 
the matter of Lues Venerea may occasionally produce 
sores which terminate in cancer will not be disputed; 
but we are not from this to conclude, either that the 
matter of the two diseases is the same, or that cancer 
should be considered as a symptom of syphilis. 

Besides the pains resembling rheumatism, which oc- 
t;ur in Lues Venerea, and of which we had occasion 
to speak when treating of nodes and affections of the 



Sec. 1{. OF LUES VENEREA* 83 

periosteum, pains of a different kind are apt to take 
place in the more advanced stages of the disease. 
They do not remain fixed or permanent, but produce 
sharp momentary stings, without leaving swelling or 
any other mark behind them. They are most frequent 
in the neck, temples, and jaws, In the latter they are 
often suspected to proceed from carious teeth, when 
on examination no affection of this kind can be per- 
ceived, or if there are any, no relief is obtained from 
pulling them. A falling out of the teeth has been fre- 
quently described as a symptom of Lues Venerea* 
but I have never met with it excepting where the pa- 
tient had taken a great deal of mercury, and where it 
appeared evidently to proceed more from the medi- 
cine than from the disease. 

One of the most frequent symptoms of the advanc- 
ed stages of syphilis is atrophy, or a gradual wasting 
of the body. This is no doubt a frequent effect of a 
mf rcurial course, particularly when too much of the 
medicine has been exhibited; but it is also a symptom 
of the disease. Even where little or no mercury has 
been given I have known a patient become much ema- 
ciated in the course of a short time. From a state of 
obesity, and with a healthy, florid complexion, a 
person will in some instances become suddenly lean, 
while his face will be wan or sallow, as if the vessels 
were altogether deprived of red blood. This I con- 
sider as one of the most fatal symptoms of the disease, 
from which, in the course of my observation few or 
none have ever recovered. 

Irritability and restlessness are two symptoms of 
this disease. When Lues Venerea has been of long 
duration the system becomes so irritable that the most 
trifling occurrences prove distressful. No application 
can be given to business ; the patient becomes fret 
ful and uneasy, and his nights are spent in watch? 

The constant anxiety which takes place here is of- 
ten connected with that state of atrophy which we 
have just described.- It seems in some cases indeed 
to be the cause of it. Being always accompanied 



84 OF THE SYMPTOMS CI). IV. 

with an entire loss of appetite this of itself soon redu- 
ces the body to the most emaciated state. 

But the most universal symptom of the anomalous 
liind which prevails in Lues Venerea is fever. Nor is 
it confined to one stage of the disease. Occasionally 
it takes place in all of them. It is necessary, howev* 
er, to remark, that the fever which occurs in the com- 
mencement of the disease is very different from that 
which most frequently prevails afterwards. The first 
may more properly be considered symptomatic, being 
always connected with some local affection, such as 
bubo, sore throat, ulcer, or node, while the other of- 
ten takes place where no other mark of the disease 
can be discovered. The one therefore subsides along 
with the particular cause by which it was produced, 
while the other continues obstinate as long as the vi- 
rus of the disease remains in the constitution. It is. 
this last, therefore, which is of most importance, and 
merits most of our attention. 

This fever is always of the hectic kind, and accom- 
panied with some colliquative symptom, particularly 
with nocturnal sweats. Hence the patient soon be- 
comes emaciated, but a peculiarity occurs here not 
met with in other fevers; at the same time that the pa- 
tient becomes languid and reduced he is commonly 
able to transact his ordinary business, and often con- 
tinues to do so for a considerable time after the fever 
has taken place. He is liable to alternate fits of cold 
and heat ; particularly to much warmth over the whole 
body in the evening ; to restlessness and anxiety during 
the night, and to a constant quickness of pulse ; but 
these symptoms, while they do not come to any great 
height, do not excite much alarm, and the patient, 
while no local affection takes place, continues daily in 
hopes of getting free of them. 

For a considerable time both the patient and practi- 
tioner find it difficult to account for these symptoms* 
They are often attributed to cold ; in some cases to an 
incipient phthisis; and in others to serophula. Reme- 
dies for one, or perhaps for v\\ of these diseases, are 
accordingly prescribed, and no advantage being deriv- 



Sec. n. of lues venerea. 85 

ed from iliem, the real cause of the fever either is not 
discovered, or at last the disease breaks out in some 
such obvious form as leaves no cause for doubt. 

Among other reasons of this uncertainty may be 
mentioned an opinion which much pains has been taken 
to inculcate, and which of late has unhappily begun to 
prevail among those who have not had sufficient op- 
portunities of being enabled to judge for themselves, 
If has been with much confidence asserted, that the 
matter of Lues Venerea cannot exist in the svstem, so 
as to induce any symptom of disease, without shewing 
itself upon the surface of the body, or in some such 
manner as to be at once clear and evident. We shall 
soon have occasion to enter more fully upon the con- 
sideration of this question, but at present I may ob- 
serve, that the opinion to which I allude, although 
supported with some ingenuity, appears to be alto- 
gether void of foundation, being directly contrary to 
the observation of all practitioners of experience; for 
I hold it as a certainty that this matter of Lues Vene- 
rea often exists in the constitution for a great length 

1 of time, and is productive of fever, as well as a vari- 
ety of other symptoms, where no local affection ever 
ensues. It may happen where no mercury has been 
employed; but we meet with it most frequently where 

I this medicine has been used, but not in sufficient quan- 
tities for effecting a total removal of the virus; where 
it therefore remains in the system, and after lurking 
there for a longer or shorter period, according to cir- 
cumstances, either breaks out early in an obvious man- 
ner, or before doing so excites fever or some other 
anomalous symptom of a still less suspicious nature. 

In all such cases of doubt and uncertainty we must 
be directed entirely by the history of the rise and pro- 
gress of the complaint, and by our own observation 
in affections of a similar nature. 



The ehops or clefts in the hands and feet of which Mr. Bell 
speaks, are commonly called R/iagades. They are seldom station- 
ary, but come and go, until some other more considerable symptom 
takes the lead, in which case they sometimes disappear entirely, 



8j6 of the venereal virus. Ch. iv. 

The venereal Rhagades differ from the leprous, in being strongly- 
marked with the copper hue. The latter is a large, thick, white 
and hardened kind of crust ; the former though somewhat scurfy , 
is not so dry, is yellowish, and is more like a common fissure or 
chop of the skin. (Howard.) Dr. Willan observes, that Rhagades 
may be distinguished from Psoriasis Palmaria, in their not affect- 
ing the toes and fingers. In the latter disease, the colour of the 
scurf is also darker. (Willan on Cutaneous Diseases, vol. 1. p. 
165.) Some authors are of opinion that Rhagades are never the 
effect of Lues. Dr. Adams in particular, states that they are com- 
mon in warm climates, and that the sole cause producing them, is 
the inability to perspire freely. (Adams on Morbid Poisons.) 

That thickening of the integuments of the scrotum which is men- 
tioned above, is the venereal form of the Psoriasis Scrotalis, de - 
scribed by Willan. Ed. 



SECT. III. 

Of the Venereal Virus, 

HAYING in the different parts of the preceding 
section given a description of the various symptoms 
of this disease, I shall now offer a few remarks upon 
the virus by which they are produced. 

Of the real nature of the venereal virus no correct 
knowledge is obtained ; and as it can never be procur- 
ed in a simple state we can scarcely expect that much 
satisfaction would result from any enquiries that could 
be made concerning it. We meet with it most fre- 
quently mixed with pus or mucus, and sometimes with 
blood and serum ; but so intimately is it blended with 
these fluids, and so little are we acquainted with the 
peculiar appearances of this matter, that we are not 
able to distinguish it. By some the matter of Lues 
Venerea has been supposed to be of an acid nature; 
others consider it as alkali. One set of practitioners 
have said that it is of putrescent quality, while others 
assert the reverse. It is evident, however, that all 
such opinions must be merely hypothetical, so long as 
the matter to be investigated cannot be made obvious 
to the senses in an uncombined state. 

But although there may be some circumstances rela- 



SeC. III. OF THE VENEREAL VIRUS. 87 

tive to the matter of syphilis which we may never be 
able to explain, there are others which we can trace 
with some precision, and upon which I now mean to 
make a few observations. The circumstances to which 
I shall advert resolve themselves into the following 
questions: Upon what parts does the matter of syphi- 
lis chiefly act in producing Lues Yenerea ? When re- 
ceived into the system can the poison remain there 
without producing the disease ? And is it possible for 
a person with the virus in a latent state, and without 
any mark of disease, to communicate the infection to 
others ? 

Various opinions have prevailed upon the manner in 
which the matter of diseases enters the constitution. 
Some contend that it is taken up solely upon the sur- 
face of the body ; others that it enters perhaps entire- 
ly by the lungs ; while some are of opinion that a great 
proportion of diseases take their origin in the stomach 
and alimentary canal. But the point upon which pa- 
thological writers have chiefly differed is, Whether 
the matter of disease, when it has once entered the 
system, acts most particularly upon the solids or fluids? 

The humoral pathology, as it is called, prevailed 
universally for a great length of time. Diseases were 
supposed to be seated chiefly, if not entirely, in the 
fluids; and so generally was this opinion received, that 
although others were occasionally proposed, they were 
considered only as innovations, and for the most part 
soon fell to the ground. 

Of late, however, the opposite doctrine has begun 
to be more generally received, and it has become fash- 
ionable to explain the phenomena of every disease, and 
the operation of almost every medicine employed for 
curing them, by their influence upon the solids. To 
me it appears that both opinions have been carried too 
far ; and while one party have supported one opinion, 
and the other the very reverse, that it is probable no 
disease of the constitution can take place without eve- 
ry part of the system being affected. I think it evi 
dent, however, that every disease produced by conta- 
gion acts first upon the fluids, and that the solids are 
ultimately affected in a secondary way only. 



38 . OF THE VENEREAL VIRUS. CI). IV. 

In Lues Venerea this appears to be still more clear- 
ly the case than can be demonstrated in almost any 
other disease ; a circumstance, however, that tends to 
support the general principle of the doctrine, even 
where this kind of proof cannot be obtained ; for if 
it obviously happens in one disease where the matter 
of infection can be clearly shown to affect the fluids in 
(he first instance, we have reason from analogv to con- 
elude that it may likewise be so in others, although it 
may not from a concurrence of circumstances be in- 
cur power to show it. 

To enter fully upon the consideration of this doc- 
trine, a greater length of discussion would be requir- 
ed than the nature of this work will admit. I shall 
therefore only mention shortly such circumstances as 
tend most clearly to establish the opinion which I 
adopt; and even this might have been unnecessary if 
there was not reason to suppose that much inconsistent 
practice would be the consequence of that opinion be- 
ing admitted, which of late a great deal of pains has 
been taken to establish. 

Whatever may be the case in other diseases, that 
the fluids are chiefly affected in Lues Venerea is ren- 
dered evident by the following circumstances. 

I. The contagious matter of this disease is always 
communicated in a fluid form. But it is alleged, al- 
though this is the case, that even upon its first applica- 
tion it shews a tendency to act chiefly upon the solids, 
by exciting inflammation wherever it is applied. This 
appears, however, to be only an accidental, not an 
essential property of the matter; for instances are fre- 
quent, as we have already had occasion to remark, in 
which it enters thesystem without inducing either infla- 
mmation or erosion. By the acrimony which the mat- 
ter seems to possess, inflammation most frequently takes 
place on the spot to which it is applied, by which the 
corresponding absorbents are with more certainty 
made to receive it than might otherwise be the case ; 
but no other conclusion can be drawn from this. It 
happens here, as we have already had occasion to re- 
mark on the practice of inoculating for the small pox, 



Sec. III. OF THE VENEREAL VIRUS. 89 

that the matter of infection does not readily enter the 
system where inflammation is not excited ; but surely 
few will suppose that we would fail in producing either 
of these diseases, were we possessed of any method of in- 
troducing the matter into the common course of circu- 
lation without exciting inflammation. Even this, how- 
ever, has been alleged by some ; but besides other cir- 
cumstances which might be mentioned as proofs of the 
contrary, the clearest evidence of it is obtained, and 
of inflammation not being essentially necessary for 
the production of small pox, from the manner in which 
the natural form of the disease usually appears, where 
no inflammation, or any other local affection is per- 
ceived, till the disease has taken place, when the first ef- 
fects that occur from it are, fever, and quantities of mat- 
ter thrown out upon the surface. This takes place in a 
more obvious manner in small pox, but it also happens 
in Lues Yenerea, in which a great proportion of the 
symptoms are evidently produced by contagious mat- 
ter of a similar nature to that which first entered the 
lymphatics at the time of infection, for the matter 
produced by venereal ulcers and eruptions will \ery 
certainly produce every symptom of the disease, if 
by any means it is thrown into the system of a sound 
person. Of this every practitioner, I presume, is so 
much convinced, that even those who have thought 
proper in theory to support a contrary opinion would 
not willingly expose themselves to the hazard of being 
infected with matter of this kind. 

2. ft has been a question agitated with some warmth, 
in what manner does the virus act on being conveyed 
to the mass of blood? At one period fermentation 
was considered as a principal agent in producing dis- 
ease. The matter of infection being received into the 
circulation, it was supposed by means of fermentation 
to possess a power of converting the whole fluids of 
the body into its own nature. This opinion, howev- 
er, was liable to various objections, and particularly to 
this, that it is difficult to conceive how fermentation 
can go on in fluids in circulation. In a state of ex- 
travasation we can easily suppose that it may happen ; 

vot ? Hi 12 



90 OP THE VENEREAL VIRUS. Cb. IT. 

but while life subsists the fluids are kept in such per- 
petual motion that we cannot easily conceive how 
such a process can take place. But although fermen- 
tation, in the full acceptation of the word, may not 
occur from this cause, I think it highly probable 
that the matter of all contagious diseases, and more 
especially the matter of Lues Venerea, has a power 
of assimilating to its own nature a certain portion, 
and ultimately, perhaps, the whole fluids of the 
body. . 

3. This power may be quick or slow in its progress 
according to a variety of circumstances, but which, 
from our limited knowledge of the laws of the an- 
imal ceconomy, it may never be in our power to as- 
certain. 

4. While the quantity of matter thus assimilated is 
inconsiderable no marks of disease will be produced, 
nor will any effects result from it till it prevails in 
such quantity as to be capable of exciting some de- 
gree of morbid irritability in the living principle. 

6. From all this I conceive that in Lues Venerea 
the matter of contagion acts in the first instance upon 
the fluids, and that the solids are not otherwise affect- 
ed, than in being excited by this m'orbid state of the 
fluids to some degree of unusual exertion for the 
purpose of throwing them off, by which eruptions on 
the skin are produced, with ulcers of different parts, 
as well as all the other symptoms of the disease. 

6. From this view of the origin of Lues Venerea 
we account for the matter of contagion remaining 
longer inactive in some instances than in others. Be- 
sides any difference which may take place in the state 
of the fluids upon which the matter has to act, and by 
which the assimilation to which we allude may be ac- 
celerated or retarded, the different degrees of irrita- 
bility which prevails in different persons, and even in 
the same person at different times, will also co-operate 
in producing an early or later formation of the symp- 
toms; for while some are easily stimulated, and may 
therefore be acted upon almost as soon as the matter 
of contagion enters the system, others ©f more slug^ 



SeC. in. OF THE VENEREAL VIRUS. 9| 

gish temperaments may, for the production of the 
same effect, require the matter to be accumulated in 
such quantities as nothing but a great length of time 
can accomplish. 

7. It may be said in opposition to this opinion, that 
as soon as this accumulated state of morbid matter is 
accomplished the effects of it should appear equally 
upon every part of the body ; for the fluids circula- 
ting over the whole, the effects of any disease to which 
they are liable should not be confined to particular 
parts, as we find to be the case in Lues Venerea. To 
this it may be answered, that many inexplicable cir- 
cumstances occur in every disease, and that in this re- 
spect the venereal disease is not different from a varie- 
ty of others in which particular parts are more apt to 
be affected than others, and where it is equally diffi- 
cult to explain why they should be so. Thus it is as 
impossible to say, why the matter of gout should fix 
must frequently upon the great toe as it is to explain 
the cause of the throat and nose being particularly 
apt to suffer in Lues Venerea. There may be some 
kind of attraction between particular parts and the 
matter of certain diseases; or these parts may be more 
easily irritated than others, and which ever of these 
may be the case the same consequences will ensue. 

8. It is asserted by those who support the contrary 
opinion, that we cannot in any instance discover the 
cause of disease to be in the fluids. This indeed they 
are under the necessity of doing in order to give the 
appearance of probability to their theory in any case. 
By discovering therefore, that this assertion is ill- 
founded, and that in other instances the fluids are ob- 
viously affected, we might from analogy say, that they 
are so in Lues Yenerea, were the proofs which we 
have adduced of it less evident than we have shown 
them to be. Now the action of several other poisons 
is rendered evident to the senses. This is particularly 
the case with the poison of different kinds of vipers, 
in which serous effusions take place in different parts 
of the body, often in the course of a few houis from 
the time of the bite being inflicted, and in which the 



92 OF THE VENEREAL VIRUS. Ch. IV. 

colour of the whole serum of the blood is even in that 
short space of time tinged of a morbid yellow colour* 

9. They who are of opinion that the cause of disease 
is not seated in the fluids are under the necessity of de- 
nying in more instances than one, what in Lues Vene- 
rea is well known to be matter of fact. They are obli- 
ged to say that the blood is perfectly sound, and that 
neither this fluid, nor any of the secretions produced 
from it are capable of communicating infection. A 
theory being once formed, every argument that mili- 
tates against it is apt to be overlooked, while, in order 
to support it, facts are explained away in a manner 
which they will not bear. This, in some instances, 
may be followed by very pernicious consequences, par- 
ticularly where such modes of reasoning are adopted 
and promulgated by authors of ingenuity and reputa- 
tion ; and as Mr. Hunter of London has gone farther 
than any other author in support of the opinion that 
the syphilitic virus cannot be conveyed by or affect the 
fluids, the following observations will relate particular- 
ly to his work.* 

" We may observe (says Mr. Hunter) that even the 
blood of a pocky person has no power of contaminat- 
ing, and is not capable of giving the disease to anoth- 
er even by inoculation; for if it were capable of irri- 
tating a sound sore to a venereal inflammation, no per- 
son that had this matter circulating, or had the Lues 
Venerea, could escape having a venereal sore, when- 
ever he is bled, or receives a scratch with a pin, the 
part so wounded turning into a chancre," &c. Vide p. 
292. Now Mr. Hunter here assumes as matter of fact 
what is not the case; for although all wounds inflicted 
upon patients labouring under Lues Venerea do not 
become venereal ulcers, yet frequently, and in almost 
every instance of the more advanced state of the dis- 
ease they do so. I have at this time a gentleman un- 
der my care whose case affords an instance of this, 
where the bites of leeches applied to the scrotum on 
account of inflammation of one of the testes, the cozr? 



f Vide a quarto edition, published in 178& 



Sec. III. OF THE VENEREAL VIRUS. 93 

sequence of Gonorrhoea, degenerated into venereal 
sores. This I informed him would not have happen- 
ed from Gonorrhoea alone. And upon enquiry he ac- 
knowledged that six months ago he laboured under 
chancres and bubo, for which he suspected that he had 
not used enough of mercury, and that for a week past 
he had felt uneasiness in his throat, where I found, on 
inspection, that an ulcer had already formed on one of 
the tonsils. 

In the course of business I have met with a variety 
of similar cases, and every practitioner must have done/ 
so. It must be remarked, however, that we have sel- 
dom occasion to take blood, either with the lancet or 
leeches, in symptoms truly venereal. It is in Gonor- 
rhoea chiefly that this remedy becomes necessary; a 
circumstance, I may observe, that affords a farther 
proof of the difference of the two diseases ; for while 
the symptoms in Gonorrhoea are often so acute, and the 
inflammation so violent, as to render it necessary to 
discharge a good deal of blood, this almost never hap- 
pens in Lues Venerea, a disease in which the parts af- 
fected become red and of a copper-colour, accompanied 
with some degree of uneasiness, but in which that kind 
of inflammation requiring blood-letting scarcely ever 
takes place. 

Mr. Hunter was resolved, however, not to rest sat- 
isfied with asserting that the blood of a venereal pa- 
tient could not communicate infection. In the same 
page, viz. 292, he even says, that the matter produced 
by such ulcers as occur in Lues Venerea is not vene- 
real, and that it will not produce the disease. That 
there may be no suspicion of mistake on my part, I 
shall transcribe his w 7 ords. " When the matter has got 
into the constitution it from thence produces many lo- 
cal effects on different parts of the body, which are in 
general a kind of inflammation, or at least an increas- 
ed action, occasioning a suppuration of its own kind ; 
it is supposed that the matter produced in consequence 
of these inflammations, similar to the matter from a 
Gonorrhoea or chancre, is also venereal and poisonous. 
This 1 believe till now has never been denied, and up- 



94 OF THE VENEREAL VIRUS. Ch. IV, 

on the first view of the subject, one would be inclined 
to suppose that it really should be venereal; for first 
the venereal matter is the cause; and again the same 
treatment cures both diseases; thus mercury cures 
both a chancre and Lues Venerea ; however, this is no 
decisive proof, as mercury cures many diseases besides 
the venereal. On the other hand, there are many 
strong reasons for believing that the matter is not ve- 
nereal. There is one curious fact, which shows it is 
either not venereal, or if it be, that it is not capable of 
acting in some respects on the body or same state of 
constitution, as that matter does which is produced 
from a chancre or Gonorrhoea. The pus from these 
latter, when absorbed, generally produces a bubo, as 
has been described, but we never find a bubo from the 
absorption of matter from a pocky sore; for instance, 
when there is a venereal ulcer in the throat we have 
no buboes in the glands of the neck; when there are 
venereal sores on the arms, or even suppurating nodes 
on the ulna, there are no swellings of the glands of the 
arm pit, although such will take place if fresh venereal 
matter is applied to a common sore on the arm, hand, 
or fingers," &c. 

Now all this is such loose reasoning as could not 
have been looked for in a man of Mr. Hunter's expe- 
rience and observation. His overlooking every argu- 
ment militating against his favourite theory can alone 
account for it. If the fact be not general no depend- 
ence can be placed upon it. If it be general it is not 
curious: neither is it the case that the matter of chan- 
cres and Gonorrhoea generally produces buboes. The 
matter of chancres often does, but it much more fre- 
quently does not; and few practitioners, I believe, will 
say that buboes are frequent consequences of Gonor- 
rhoea. 

I cannot say what may have been the result of Mr. 
Hunter's experience, but I have met with many in- 
stances of buboes, or swelled glands, in the thigh, ax- 
illa, and neck, as obviously produced by sores in the 
feet, legs, hands, and throat, as buboes commonly are 
in the groin from chancres on the penis. But admitting 



Sec. Iff. OF THE VENEREAL VIRUS, 95 

( 

that the occurrence is not frequent, still this is no rea- 
son for supposing that the matter of these sores is not 
venereal. If the matter be not absorbed no more harm 
will ensue from it than if it had never been formed; 
and in section II. of this chapter I have shown that it 
is not so frequently absorbed as the matter of chan- 
cres. The reason of this I have also endeavoured to 
explain, by shewing, that some degree of irritation is 
required for the purpose of exciting the absorbents to 
action; and as the matter of Lues Venerea seems to 
possess very little power of exciting irritation, except- 
ing such as is produced by the primary sores of the 
disease, it is accordingly seldom absorbed, and stilt 
less frequently does it produce buboes ; for being of a 
mild nature it does not so readily stimulate the lym- 
phatics, so as to produce obstructions in the glands as 
it goes along. 

Mr. Hunter would have found it difficult, or even 
impossible, to explain consistently with his theory of 
the disease, a number of circumstances which we dai- 
ly observe. He therefore denies that they exist; and 
he seems to have no difficulty in doing so, even where 
they are admitted by all unbiased practitioners. In 
page 291, he says, " It is also supposed that a foetu? 
in the womb of a pocky mother may be infected, and 
have the disease from her, as it were naturally inter- 
woven with it. This I should doubt very much," &e. 
And in page 295, he says, u It has been supposed, and 
asserted from observation, that ulcers in the mouths 
of children from a constitutional disease, which con- 
stitutional disease was supposed to be derived from the 
parent, produced the same disease upon the nipples of 
women who had been sucked by them giving it as it 
were at the third hand ; that is, the children were con- 
taminated either by their mother's or father's having 
the disease in form of a Lues Venerea, of which I have 
endeavoured to show the impossibility." 

Mr. Hunter has certainly endeavoured to shew the 
impossibility of this, for his system could not other- 
wise have had the least plausible appearance; but none, 
excepting such as have not had opportunities of being 



96 OF THE VENEREAL VIRUS. Cll. IV. 

able to form judgments for themselves, will say that 
he has proved successful. If I can give credit to any 
fact with which I am acquainted I must believe in this, 
that children may receive, and frequently do receive 
the venereal disease from their parents labouring un- 
der it in a constitutional form; and that ulcers in the 
mouths of these children will, and frequently do pro- 
duce the same disease upon the nipples of women 
whom they suck. Nay, that these will give it again to 
other children, and these children to other nurses; 
circumstances which I have so frequently witnessed, 
so strongly marked, and followed by consequences so 
distressful to innocent sufferers, that I cannot help 
expressing astonishment that a practitioner of any ex- 
perience should entertain a doubt of their existence. 

Mr. Hunter, in page 296, proceeds to say, with 
some appearance of exultation, as judging it to be an 
unanswerable argument, that " were it possible to 
contaminate once in this way it would be possible to 
contaminate for ever ;" a circumstance which he 
seems to consider as ridiculous : But surely all this 
would happen. Nurses and children infected in this 
manner would undoubtedly continue to communicate 
the contagion to others as long as they were not cu- 
red of the disease. Nor would there be any tiling in 
all this that does not daily happen ; and in whatever 
way the disease is communicated we have reason to 
think that it would be the case. 

In order I suppose to convince others that he him- 
self at least is convinced of the opinion which he sup- 
ports being well founded, Mr. Hunter, in p. 12, goes 
even farther than any thing I have yet mentioned 
That the venereal disease is to be propagated only by 
matter is proved every day, he says, by a thousand in- 
stances. And in the belief of this being the case he 
afterwards observes, that he has gone so far as to allow 
married men who had contracted the disease to cohab- 
it with their wives, in order to save appearances, and 
always with safety ; Nay, that he could carry this still 
farther, and allow a married man who has a Gonor- 
rhoea to have connexion with a sound woman, if he 



SeC. IT. OF THE VENEREAL VIRUS. 97 

took care to have all the parts cleared of matter, by 
syringing the urethra, making water, and washing the 
glans. 

I believe with Mr. Hunter, and every practitioner 
perhaps will do so, that the risk of communicating in- 
fection will not be so considerable where no matter is 
formed as where ulceration actually takes place : but 
I also know, that a woman would run much risk of 
being injured by cohabiting with a man whose blood 
was infected with matter of syphilis, although no lo- 
cal marks of it should appear, for I have met with 
various instances of it ; and I also know from a varie- 
ty of facts, that both father and mother, in situations 
such as this, and where no bad symptoms were ever 
perceived, have communicated the disease to the foetus. 
Where this has happened from the mother being in- 
fected, the matter of contagion must pass from the 
mother to the child along with the blood; but where 
it takes place from the father, as is most frequently 
the case, there is no other mode by which it can be 
conveyed but by the semen. We shall have occasion, 
however, to make some farther observations upon 
this subject when treating of Lues Venerea in new- 
born infants. 

From all that I have said, I think it will appear that 
the matter of contagion in Lues Venerea, in the first 
place, acts upon the blood alone ; that by accumula- 
tion it comes to irritate the solids or containing parts, 
and in this manner that effusions and consequent ul- 
cerations are produced ; that the venereal poison may 
remain long latent in the system ; that this will de- 
pend upon the irritability of the person, as well as 
upon the particular state of the fluids at the time, by 
which they may be more or less liable to the assimila- 
ting effects of the matter of contagion ; and lastly* 
that there is no cause of doubt that a person with the 
virus in this latent state, and without any external 
mark of disease, will communicate the infection to 
others. 

vol. it* 13 



98 OF THE REMEDIES USED Ch. IV. 



It is sufficient, in remarking on this section to observe, that fur- 
ther experiments on several points are required in order fully to- 
substantiate Mr. Bell's opinions. We are much inclined to doubt 
the correctness of his remark, that a person labouring under con- 
stitutional symptoms can communicate the disease. The observa- 
tions of Mr. Hunter and his disciples on the mode in which the ve- 
nereal virus is introduced, and the manner of its acting, are worthy 
of an attentive examination. Mr. Pearson observes, that he has 
seen a number of persons afflicted with lues venerea pass through 
violent fevers, inflammatory diseases, small pox, &c. without the 
patient receiving the least benefit as to the former complaint. He 
adds however, that the change in the female constitution which is^ 
connected with pregnancy, has often a wonderful power of sus- 
pending the progress and of modifying the form of the disease. 

Ed, 



SECT. IV. 

Of the Remedies used in Lues Venerea, 
$ 1. General Observations, 

AS no disease has engaged more of the attention of 
practitioners than Lues Venerea, so there are perhaps 
none in which more remedies have been employed. To- 
wards the end of the fifteenth century, when the first 
accurate description was given of this disease, a great 
variety of remedies was proposed for it ; and as it 
daily increased in violence till the use of mercury 
was introduced, scarcely an article in the materia med- 
ica was left untried in the short space which elapsed 
between this period and the fortunate discovery of this 
powerful antidote. 

Even long subsequent to this many new remedies 
were brought forth; for while meicury seldom fails of 
curing the disease, it was soon found to be produc- 
tive of many inconveniences. Every country has 
accordingly been ransacked, but after all the research- 
es that have been made> the number of articles em? 



Sec. IV. IN LUES VENEREA. 99 

ployed in modern practice for the cure of this disease 
is very few; and it is these only which I now mean to 
mention. The others, having been found either alto- 
gether inefficacious, or comparatively of weak pow- 
ers to those which are retained, have necessarily fal- 
len into disuse, so that now it would be considered as 
superfluous to speak of them. 

The only antisiphilitic medicines now in general 
use, are mercury, guiacum, sarsaparilla, mezereon, 
and opium ; Of each of which I shall speak sepa- 
rately. 

$2. Of Mereury. 

I. General Observations upon Mercury. 

Mercury having been long employed for the cure 
of a great variety of herpetic affections, we are not 
surprised at finding it early introduced in the treat- 
ment of Lues Venerea, in which the most obvious of 
the symptoms chiefly affects the integuments of the 
body. Besides, as it was universally known to be 
one of the most active medicines that had ever been 
made use of we can easily suppose that practitioners 
would soon be induced to employ it for the removal 
of a disease which resisted the effects of every other 
Remedy. 

Mercury in its crude state is found to be nearly 
inert, or not capable of producing any active effect, 
insomuch that it may be taken into the stomach in 
very considerable quantities. It has been swallowed 
to the extent of several pounds weight, and repeated 
daily for two or three weeks together with scarcely 
any effect being perceived from it ; so that wherever 
it has proved active when used in this state as in a few 
instances has happened, it must probably have been in 
consequence of its meeting with some unusual degree 
of acidity in the stomach or intestines. 

This inactivity of mercury in a crude state seems 
to depend entirely upon its insolubility in the fluids 
which it usually meets with in the human body. In, 



1U0 OF THE REMEDIES USED Ch. IV. 

this state it either is not absorbed, or if absorbed, by 
not being soluble it remains inert. 

I shall afterwards point out the different means em- 
ployed for rendering mercury active, and for introdu- 
cing it into the system, but previous to this it will be 
proper to offer a few observations upon the ordinary 
effects of mercury, and upon the different opinions 
which have prevailed respecting its mode of action in 
curing the venereal disease. 



On the first appearance of the Venereal Disease, correctives of 
the blood, evacuant medicines, venesection and similar means were 
used. As early as Vhe year 1497, mercury was externally exhib- 
ited in syphilis, but was not administered very freely. About 
1517, Guaiac was recommended as a specific, and supplanted 
the use of mercury, until Paracelsus again introduced the latter 
s*nd demonstrated its superior efficacy. (Cabinis* Sketch of the 
Revolutions of Medical Science. See a Note by Dr. Henderson, 
the Translator, p. 416.) 

Mr. Howard observes, that to Bercngarius Carpensis or his dis- 
ciple Vigo, we must attribute the promulgation of the important 
fact that mercury would cure by making the mouth sore. 

Ed. 

II. Of the Effects of Mercury upon the Human Body. 

One of the most certain effects of mercury is, that 
it acts as a cure for the venereal disease. It so sel- 
dom fails indeed, that when it happens not to succeed, 
as occasionally is the case, we are apt to suppose that 
this proceeds either from the medicine not having been 
properly administered; from its not having been giv- 
en in sufficient quantity ; or from the complaints for 
which it is used not being altogether venerea!. 

Besides this, mercury is perhaps one of the most 
universal stimulants with which we are acquainted. 
Even in small quantities it often excites heat over the 
whole body, quickness of pulse, and other symptoms 
of fever. 

It is also a very powerful evacuant. Other medi- 
cines act with equal certainty upon particular organs, 
of which we have examples in the effect of ipecacuan 
Upon the stomach, and of jalap, aloes, and other pur- 



SeC. IV. IN LUES VENEREA, 101 

gatives upon the intestines; but we know of none 
which so generally affects all the secretions. Almost 
all preparations of mercury will act as purgatives. 
They also produce sickness, nausea, and vomiting. 
They often excite an increased discharge of urine ; 
and fesv medicines operate with more certainty upon 
the skin, for they can scarcely be employed without 
being productive of some degree of diaphoresis. 

The most remarkable effect, however, which we 
perceive from mercury is an increased discharge of 
saliva ; and it is perhaps the only medicine which 
from internal exhibition is known to act with any cer- 
tainty upon this secretion. It first excites some de- 
gree of fcelor in the breath, which is often accompani- 
ed with a gentle nausea, and very commonly with the 
taste of copper. The gums become red, full, and 
somewhat tender. The salivary glands become hard 
and turgid, and at last an increased flow of saliva takes 
place, accompanied with a good deal of pain in chew- 
ing, and with a loose vacillating state of the teeth. 
For the most part this increased quantity of saliva bears 
some proportion to the quantity of mercury that has 
been exhibited ; but this does not always happen, for 
occasionally we meet with cases in which a very great 
and long continued discharge of saliva is excited by 
the smallest dose of mercury that is usually given. 

In such instances, if the farther exhibition of the 
medicine be not managed with much caution, besides 
a great flow of saliva, and swelling of the salivary 
glands, a very distressful tumefaction takes place over 
all the contiguous parts, and particularly of the tongue 
and fauces. This also happens wherever mercury is 
given in too great quantities, and especially if the pa- 
tient is suddenly and unexpectedly exposed to cold 
or dampness. Where this takes place to any consid- 
erable degree the whole surface of the mouth over all 
the inside of the cheeks, the tongue, uvula, and gums, 
are apt to ulcerate, and the matter which ensues from 
mixing with the saliva gives it both an additional fcetor 
and an ugly, sanious appearance. 

Besides the usual symptoms of fever mercury is apt 



J 02 OF THE REME3HES USED Ch. IT. 

to excite restlessness, anxiety, general debility, and a 
very distressful irritable state of the whole system. 

These are the ordinary effects of mercury, and we 
shall presently have occasion to see that in the treat- 
ment of Lues Venerea one of the greatest difficulties 
we meet with is the management of this medicine; for 
while the cure of the disease often requires it to be 
given in considerable quantities, the constitution is 
apt to be materially injured if it be not exhibited with 
the greatest care and attention. 

III. Of the Operation of Mercury in the Cure of Lues 

Venerea. 

Various opinions have been offered of the action of 
mercury in the cure of this disease. It would be for- 
eign to our purpose, however, to enter minutely into 
the consideration of any of them. I mean therefore 
to make only a few observations upon such as have 
been most generally received, and chiefly upon that 
which in my opinion ought to be adopted. 

1. Some have imagined that mercury acts chiefly in 
the cure of Lues Venerea by exciting a dissolved or 
putrid state of the fluids, which they conceive to be a 
state favourable for the peccant or morbid matter of 
the disease being thrown off from ihe system. 

The chief foundation of this opinion is the fcetor 
which we commonly perceive in the breath of patients 
under a course of mercury, and the increase with 
which it is usually attended of almost all the secretions. 

When we find, however, that whatever excites a 
quickened state of the circulation is commonly pro- 
ductive of "an increase to all the secretions, and know- 
ing that a quickness of pulse is a very common effect 
of mercury, we conclude, that upon this principle this 
effect of the medicine is more clearly explained than 
by any other opinion that has yet been suggested. 
Besides, we know from actual observation that the 
blood, during a considerable part of a course of mer- 
cury, instead of being thin and dissolved, is of a more 
firm texture than it usually is in health. Mercury, 



Sec. IV. IN LUES VENEREA. 103 

when Ions; continued indeed, never fails to excite much 
languor and debility, with many of the corresponding 
symptoms of a putrescent or scorbutic diathesis ; but 
as many of the symptoms of syphilis are daily cured 
without this taking place, there is reason to suppose 
that this effect of mercury upon the system is in no 
way necessary for the cure of the disease. 

In confirmation of this we may remark, that all the 
slighter degrees of Lues Venerea are often removed, 
and in some instances cured, without even the saliva 
being increased in quantity or affected with fcetor: 
nay, a peculiarity of constitution sometimes occurs in 
which we cannot induce either salivation or fcetor of 
breath by all the mercury that we dare venture to 
give, and still the cure of the disease goes on, although 
not so speedily, yet with equal certainty as if these or- 
dinary effects of the remedy had been regularly in 
duced. 

2. The symptoms of Lues Venerea being consider 
ed by some as the effect of a peculiar irritation exci- 
ted by the presence of the poison in the system, they 
have also ventured to say that mercury cures the ve- 
nereal irritation, as they term it, by producing an ir- 
ritation of a different kind.* 

The reasoning, however, which has been employed 
in support of this opinion seems to be altogether hy- 
pothetical, and directly contrary to many facts which 
fall daily within our observation in the treatment of 
this disease. 

Local pains may for a time be suspended, or they 
may even be removed altogether, by irritation of a 
different kind being excited either in the contiguous 
or some more distant parts of the body ; but we know 
of no constitutional disease that has hitherto been cur- 
ed by such means. This affords, therefore, much 
cause to suppose that the opinion is ill-founded when 
applied to the action of mercury in the cure of Lues 
Venerea ; for when no such effect is found to take 
place in other diseases, we cannot, without the strong- 

* Vide Mr. Hunter's Treatise on the Venereal Disease. 



104 OF THE REMEDIES USED Ch. It. 

est proofs were given of it, be led to imagine that any 
thing so very unusual should take place here. Mr. 
Hunter indeed gives as the chief reason which he sug- 
gest in support of his opinion, that " the disease can 
in many cases be cured by raising a violent stimulus 
of another kind."* I must say, however, that I nev- 
er met with an instance of this, nor have I been able 
to hear of any who have done so; neither has Mr. 
Hunter, in treating of the method of cure, mention- 
ed any article for the purpose of curing the disease in 
this manner. 

The opinion seems to have arisen from mercury be- 
ing known to act as a very powerful stimulant ; but al 
though this will be very generally admitted, yet it is 
also well known that this stimulating effect is not only 
unnecessary for the cure of Lues Venerea, but that it 
is one of the most distressful occurrences that we meet 
with in the treatment of this disease, and that the more; 
we can counteract it, consistently with the quantity of 
the medicine to be given, the more certainly do we 
succeed. So evidently is this the case that it may be 
considered as one of the principal desiderata in this 
branch of practice, a means of throwing mercury in 
an active state into the system, and in sufficient quan- 
tity for the speedy cure of the disease without produ- 
cing these stimulating effects. Were we possessed of 
this the cure of Lues Venerea would be accomplished 
with ease, and probably in one half of the time that 
is now found necessary. With the assistance of ano^ 
dynes we in some degree counteract the stimulating 
property of mercury, but the most powerful we can 
employ, even opium itself, is not altogether sufficient; 
so that we succeed only by exhibiting the medicine in 
small quantities, and interrupting the use of it alto 
gether whenever it excites much fever, or proves oth- 
erwise so powerfully stimulating as to be productive of 
much uneasiness. 

Another obvious proof may be mentioned of thi?" 
stimulating property of mercury being in no degree 



Sec, IV. IN LUES VENEREA. 105 

necessary for the cure of Lues Venerea. From time 
to time we meet with constitutions in which none of 
the usual effects of mercury are ever produced, and 
yet even in these it does not fail of curing the disease. 
VVe have already had occasion to remark, that in some 
neither salivation nor fcetor of breath takes place from 
mercury ; but I have also met. with many in whom it 
acts with perfect certainty in the cure of Lues Vene- 
rea, although it neither tends to quicken the circula- 
tion nor to increase any of the secretions. In all such 
cases too the cure is accomplished with more ease than 
where mercury operates in the usual way; and it is 
worthy of remark, that although all the more acrid 
preparations of mercury will cure the disease, yet 
their stimulating properties are found to be so hurtful 
and unnecessary, that almost by the universal consent 
of practitioners they are now generally laid aside. 

We may farther remark, that if mercury acted in 
the cure of Lues Venerea by the irritation which it ex- 
cites, other stimulants ought also to do so ; but we 
have not one authenticated instance, either of a single 
stimulant or of any combination of medicines of this 
class having ever accomplished a cure, and which we 
cannot suppose would have been the case were the 
opinion which we are now considering well founded. 

3. Mercury being specifically mach heavier than any 
of the fluids of the human body, it was a prevailing 
idea with many that it operated chiefly in the cure of 
Lues Venerea by its weight. This opinion, however, 
seems to be equally ill-founded with the one we have just 
been considering. It has not been found that other ar- 
ticles of equal or greater ponderosity cure this disease. 
It is difficult, or even impossible, to conceive that any 
medicine can prove useful merely from its weight ; and 
we have no instance properly authenticated of mercury 
having ever been discovered in any of our fluids in a 
metallic form. 

I may also observe, that the real weight of mercury 
that enters the system in any case of Lues Venerea 
must, for the most part, be very inconsiderable. 
Where the more active preparations of it are employ- 

VOL. II. 14 



106 OF THE REMEDIES USED CI). IV. 

ed this is particularly the case; but even where tritu- 
rated mercury is used internally, the form now in com- 
mon practice, we seldom find it necessary to exceed 
three or four drachms, and this requiring the space of 
six, eight, or ten weeks, the quantity in the constitu- 
tion at any one time must at all times be trifling. 

4. The most prevalent opinion upon this question 
at present is, that mercury cures the disease by the 
evacuations which it excites. This has been support- 
ed by much ingenious argument; and as it is known 
that mercury seldom exists in the system without pro- 
ducing an increase of one or more of the secretions, 
we need not wonder at the preference which on a cur- 
sory view was given to it. I think, however, that it 
may be easily shewn that it is not in this manner that 
mercury acts in the cure of syphilis. 

If this opinion were well founded mercury ought to 
prove useful or otherwise in proportion to the evacua- 
tion which it excites. At one period this was general- 
ly believed to be the case, and accordingly the great- 
est degree of salivation that a patient could bear was 
commonly advised ; but now that the treatment of sy- 
philis is better understood, it is universally known that 
this is not necessary, nay, in many instances that it 
tends evidently to retard the cure. It happens indeed, 
as we shall hereafter endeavour to shew, that some of 
the more inveterate symptoms of Lues Venerea can- 
not always be cured but with such quantities of mer- 
cury as necessarily, in a great proportion of cases, pro- 
duce salivation to a considerable height. But we 
judge that this is merely an accidental property of the 
medicine, and not necessarily connected with the cure 
of the disease, from our being able to remove all the 
slighter degrees of it without exciting salivation, and 
from cures being in some constitutions obtained even 
of the most inveterate symptoms, without either the 
teeth, gums, or breath being affected. 

Neither does it appear that the power of mercury in 
promoting any of the other secretions is in any degree 
iiseful in the cure of Lues Venerea; at least instances 
frequently occur in which cures are accomplished with- 



SeC. IV. IN LUES VENEREA. 107 

out any sensible evacuation 'taking place. Nay, I 
have bad evident proofs of a cure being retarded by 
mercury going too freely off by perspiration ; and we 
daily meet with instances of this where it affects the 
bowels so as to excite diarrhoea. 

If mercury acted in the cure of syphilis by increas- 
ing the secretions other evacuants ought occasionally 
to cure it. But no instance of this has happened, 
while vtp cannot doubt but that it must have been fre- 
quently perceived if any advantage had ever been de- 
rived from them. The necessity of promoting one or 
other of the secretions for the cure of other diseases 
is so frequent, and Lues Venerea so often takes place 
along with other complaints, that every doubt would 
long ago have been removed. If the opinion which 
we are now considering had been well founded every 
practitioner must have observed instances of the dis- 
ease being cured by diaphoretics, diuretics, &c. but 
none will probably assert that they have done so. 

We might, a priori, suppose, that syphilis cannot 
be cured by evacuants, but we knosv from experience 
that it is so, and that they do not even afford relief in 
any of the symptoms. We can easily conceive how 
those diseases that originate from affections of the so- 
lids, particularly such as are produced by spasm, or 
stricture upon the surface, may be much alleviated, or 
even altogether removed, by the operation of diapho- 
retics. By removing the cause the effect will com- 
monly soon cease. But where the symptoms are in- 
duced by contagion in the general mass of blood, and 
where this contagion has a power of propagating itself, 
as we have shewn to be the case in Lues Venerea, it 
does not appear how they are to be removed by any 
evacuations. By the use of diaphoretics and other 
evacuants the quantity of fluids in the system will no 
doubt be lessened, but this will not alter the nature of 
those that remain: If they were diseased before, they 
will still continue so; for it is not alledged that medi- 
cines of this nature have the power of discharging 
those parts of the blood that are diseased and leaving 
such only as are sound, and yet this would necessarily' 



iG8 OF THE REMEDIES USED (jh. iy c 

be the case if the venereal disease could be cured by 
evacuants. 

5. Of all the opinions that have yet been advanced 
concerning the operation of mercury in the cure of 
Lues Venerea, that which supposes it to act as an an- 
tidote is liable to the least difficulty. This was long 
ago very universally admitted, nor was much doubt 
ever entertained of it, till attempts were made by the- 
oretical writers to account for every disease, and for 
the operation of every medicine, upon such general 
principles as are not often applicable in practice. 
Where principles of this kind are clear and evident 
they ought certainly to be adopted, but the surest 
method of having them overlooked in every case is to 
attempt to introduce them in all. By doing so absur- 
dities must often be admitted which tend to invalidate 
the whole, and by which many are led to throw aside 
reasoning in all cases, who willingly would go into it 
if our systems of theory were confined to such ques- 
tions as it is in our power to explain. 

Writers of this class deny the antidotal power of 
every medicine merely from their not being able to 
account for the manner in which they act. They do 
not consider that many of the most common opera- 
tions in chemistry are equally inexplicable. Thus no 
person can say why or in what manner the properties 
of an alkali should instantly be destroyed by an acid 
brought into contact with it. I do not say that the 
operation of mercury in the cure of syphilis is analo- 
gous to this ; but the one I think is equally incompre- 
hensible with the other, and that mercury acts in this 
disease consistently with the idea which we affix to an 
antidote is at least highly probable. What I conceive 
to be the property of an antidote, is, that when it 
comes in contact with the poison for which it is appro- 
priated, it either renders it altogether inert or so far 
changes its nature that no deleterious effects are produ- 
ced by it. How it so happens that we can bring more 
decisive proofs of this being the effect of mercury in 
the cure of Lues Venerea, than we might at first im- 
agine would be in our power in accounting for the 



Sec. IV. IN LUES VENEREA. 109 

action of any medicine in the cure of any disease. 
Among other circumstances which tend to establish 
this the following may be enumerated, 

1st, We know by experiment that the matter of 
Lues Venerea on being mixed with the triturated mer- 
cury is rendered inert, and will not produce the dis- 
ease. The fact is recorded by the best authority, the 
late Doctor Cullen, who having supported more ably 
perhaps than any other person an opposite opinion, 
we are not to suppose that he would have given room 
to what militated so strongly against it if he had not 
been convinced of the fact being well founded. His 
w r ords are, "A physician took a quantity of matter 
from a venereal chancre, and mixing it with a quanti- 
ty of Plenck's gummy solution of mercury, he ap- 
plied this mixture to a sound person, but could not 
find that it produced either chancre or any other syph- 
ilitic symptom/** This fact of itself might be judg- 
ed to be decisive, but more complete conviction is ob- 
tained of its being so from every view that we can 
take of the chief phenomena observed to occur from 
the operation of mercury in the cure of this disease. 

2dly, We have daily evidence of mercury curing 
venereal sores not merely by acting upon the disease 
in the constitution, but on being locally applied to 
chancres and other ulcers. 

In answer to this it is said that these sores may be 
cured by other articles besides mercury. Allowing 
this to be the case, it is sufficient for our purpose that 
they are more certainly and more speedily cured by 
mercurial applications than by any others ; a fact so 
notorious, that mercury in one form or other is now 
the chief dressing for chancres all over Europe. Cop- 
per has been much extolled for this purpose, but al- 
though I have used it in every variety of form, it has 
never proved equal to the different preparations of 
mercury. 

* Vide a Treatise on the Materia Me&ica bv the late Doctor William Cullen. 
Vol. II. p. 



110 OF THE REMEDIES USED Ch. IV. 

It is also said that mercury does not always cure 
venereal ulcers, which it ought we are told, to do, if 
it acted as an antidote. This kind of cavil, however, 
requires no serious answer. We may regret that our 
medicines will not cure every disease, but all will al- 
low that we are more certain of curing Lues Venerea 
with mercury than of removing any other disease by 
any remedy whatever. 

3dly, Besides these local effects of mercury upon the 
matter of Lues Venerea we have the clearest proofs 
that can be wished for its acting as an antidote to the 
virus through the whole progress of the disease. Nay, 
the very practice of those who combat this opinion 
tends to evince it, although they do not seem to be 
sensible of its doing so. The first symptom of the 
disease that commonly succeeds to chancre is bubo, 
produced, as is now universally known, by the vene- 
real virus being absorbed and lodged in a lymphatic 
gland. Now it is acknowledged by all who have paid 
attention to the subject, that our best practice here is 
to bring the mercury we mean to employ as quickly 
as possible into contact with the virus lodged in the 
obstructed gland. Nay, of so much importance is it 
that this should be done, that although we may pre- 
vent the system from sufferings by throwing the medi- 
cine in a different manner, yet no other practice will 
prevent the virus from continuing to irritate the ob- 
structed gland till it is at last thrown out by a complete 
formation of matter. Now in what manner does the 
mercury act here? It cannot be by dissolving the tex- 
ture of the blood, for we have already shewn that 
this does not happen if it be not from a course of mer- 
cury being long continued, while buboes are often re- 
moved by a very short application of it. It cannot 
be by it& weight, for a few grains of it often prove 
sufficient ; and besides, it would have in most instan- 
ces to act contrary to its own gravity. It is not by ex- 
citing irritation, under any kind of modification, for 
when mercury succeeds in resolving these tumours, 
the pain produced by the first formation of them vpry 
quickly subsides, while no irritation of any other kind 



SeC. IV. IN LUES VENEREA. Ill 

ever succeeds to it. Neither does it act by exciting 
evacuation ; nor could evacuations of any kind be of 
any avail. The disease is here in a local state : In the 
formation of bubo the matter does not necessarily 
enter the system, so that there is nothing to carry off. 
I therefore think we may fairly conclude that as the 
action of mercury in the cure of buboes canuot be ac- 
counted for in any other manner, and as we find from 
the testimony of all practitioners that it has no influ- 
ence in resolving them, but when brought into direct 
contact with the venereal virus, that it proves effectu- 
al only by acting as an antidote to the virus. In my 
opinion this affords the clearest proof of its doing sa 
that can possibly be given. It even removes the ob- 
jection that has been stated to the antidotal power 
which we suppose mercury to exert in the cure of 
chancres, where it is said that these sores can be cured 
by other applications ; for in the treatment of buboes 
no practitioner has ever ventured to suppose that they 
can be resolved by the absorption of any other remedy 
but mercury. 

4thly, In tracing the effect of mercury upon the 
venereal virus still farther we have all along the clear- 
est evidence of its acting as an antidote. In the treat- 
ment of many of the symptoms of syphilis, almost as 
soon as we can suppose the mercury to have entered 
the svstem, the same kind of relief is obtained which 
we experience from this remedy when it proves suc- 
cessful in resolving buboes. This is particularly the 
case in the venereal sore throat, where a good deal of 
uneasiness generally prevails till mercury is given, and 
in which much relief is commonly obtained soon after 
it is employed, without any other irritation being ex- 
cited, and often before the medicine has produced any 
evacuation whatever. 

5thly, We conclude that the relief experienced from 
the internal use of mercury in the treatment of local 
venereal symptoms proceeds from the medicine com- 
ing in contact with the virus, in the first place, from 
our finding, as I have just observed, that it is analo- 
gous to what happens in the cure of buboes, where 






11" OF THE KEMEDIES USED Cll. IVc 

we know that the mercury is directly applied to the vi- 
rus ; and secondly, from our having convincing proofs of 
the medicine entering the circulation almost in every 
case in which it proves successful, and therefore that 
it must be applied to every part that is diseased.. 
Some indeed have alleged that mercury never enters 
the circulation. In a metallic form this may perhaps 
be the case, but that the essential parts of it pass into 
the system is obvious, not merely from its influence in 
curing diseases, but from the taste which it gives to the 
saliva, although it be absorbed at a distant part of the* 
body ; and from the effect produced by the exhalation 
of a person under mercury upon gold and silver car- 
ried in the pocket, which is exactly similar to that 
which occurs from mercury being rubbed upon these 
metals. 

6thly, It has been stated as an objection to this 
opinion, that the quantity of mercury employed for 
the cure of Lues Venerea is so small that it is difficult 
to conceive how it can have any influence upon the 
general mass of blood, to which it bears such a small 
proportion. To obviate this difficulty an ingenious 
opinion lias been offered. As we perceive the venereal 
virus to produce effects chiefly upon particular parts, 
it is supposed that all that exists of it in the mass of 
blood may be thrown out upon or be attracted by these 
parts, and therefore that the mercury employed in the 
cure, instead of acting upon the general mass of blood, 
may be supposed to exert all its influence upon the 
diseased pails only;* 

I think it more probable, however, from many of 
the phenomena of the disease, and it must undoubted- 
ly be so if the opinion I have endeavoured to support 
be well founded, that the whole mass of blood is taint- 
ed in an equal degree while any part of the contagion 
remain in the constitution, and that the mercury em- 
ployed in the cure acts equally upon every part of it 
We know that the disease itself may be produced by 
a very small particle of matter. We may just as read- 
ily suppose therefore that it may be cured by a small 

* Vide Observations on Mercury, by Dr. Andrew Duncan, professor of med- 
icine in the University of Edinburgh. 



SeC. IV- IN LUES VENEREA. 113 

quantity of any remedy that acts as its antidote; and 
it is perhaps equally difficult to explain the manner in 
which such ,a small portion of matter acts in assimila- 
ting quickly to its own nature such a large proportion 
of our fluids, as it is to account for the manner in 
which the mercury operates which we employ for cur- 
ing the symptoms produced by it. 

Upon the whole, therefore, as the action of mercu- 
ry in the cure of Lues Venerea is not accounted for 
by any other opinion that has yet been offered ; as we 
have complete evidence of this disease being at all 
times the effect of contagious matter entering the blood ; 
as the local effects of this matter are cured by mercu- 
ry, whether they appear in the form of ulcers or by- 
obstructing the lymphatic glands ; as no other remedy 
hitherto employed operates with any certainty, either 
in removing the matter from the blood, or in obvia- 
ting the effects of it; as mercury seldom or never fails 
in curing syphilis, when it can be made to enter the 
blood, if it be not in the most advanced stages of the 
disease, or when Lues Venerea is connected with oth- 
er diseases, or with such peculiarities of constitution 
as will not bear a sufficient quantity of mercury ; and 
as no instance perhaps can be adduced of a cure being 
accomplished where the presence of mercury in the 
blood was not rendered obvious either by the usual 
effects of it upon the mouth or upon gold and silver 
carried in the pocket, we have no reason to doubt of 
this remedy operating perhaps entirely as an antidote ; 
that is, by rendering the matter of contagion inert or 
incapable either of exciting the disease, or continuing 
the symptoms even after the disease has been produced. 



The following observations on the modus operandi of mercury. 
by Dr. Francis, professor of the Materia Medica in the College of 
Physicians and Surgeons in the State of New-York, contain a com- 
pressed view of the several theories on the subject, as well as anew 
one suggested by Dr. Hosack, and ably illustrated by Dr. F.-—* 
These observations we consider of so much importance, that we 
would not sin against the author by an abridgment, any more than 
we would deprive our readers of a feast they will enjoy from perus- 
ing them in the words of the author. We feel a confidence that the 
VOL. II. 15 



114 OP THE REMEDIES USED Ch. IV. 

intrinsic value of the extract will constitute a sufficient apology for 
its length. (Vid : Med : & Philosoph. Register, Vol. IV. p. 476.) 

" Numerous and discordant are the opinions which have been main- 
tained by professional men on the curative action of mercury in the 
treatment of disease ; and upon an examination into the history of 
this medicine, the most superficial observer will perceive that these 
different opinions have a relation more or less corresponding with 
the prevailing theories and physiological knowledge of the times. 
Upon the first introduction of mercury as an article of medicine, 
when it was administered in its metallic state, it was supposed to 
overcome all obstructions by its specific gravity. Upon its more 
general and successful employment by Paracelsus and others, its 
action, it was presumed, was readily explained according to the 
crude and absurd notions of the chemists. After this period its op- 
eration, in common with other remedies, was successively elucida- 
ted agreeably to the opinions of the humoral pathologists, and the 
corpuscularian doctrines of the mechanical physicians. Its peculiar 
action, however, in the treatment of lues venerea, has been more 
es ecially the subject of consideration among the most distinguish- 
ed authors who have written on that disease, as well as of those who 
have treated of the materia medica In not a few instances, it has 
given birth to the most fanciful and erroneous ideas, relative to the 
pathology and functions of the human system. Even the great 
Boerhaave, who acquired and appropriated to his own use the know- 
ledge of all preceding ages, " who examined systems by experi- 
ments, and formed experiments into systems,*'* believing the vene- 
real disease to be seated in the cellular and adipose membrane, con- 
ceived its cure was to be effected by melting down the adipose sub- 
stance by salivation.f And at the present day, after the more recent 
and popular theories of Mr. John Hunter and of Mr. Benjamin 
Boil, the modus operandi of this medicine remains a question far 
from being decided. 

Aware of the many difficulties which occur in accounting for the 
curative action of mercury in the treatment of disease, the writer 
does not' presume to suppose he can remove the obscurity in which 
this subject is involved: but as the theory of its operation will be 
the more readily understood in connexion with its effects upon the 
body, it seems necessary that they should first be briefly mentioned. 
Passing over the still more recent and more fanciful opinions en- 
tertained on this subject, by Doctors Girtanner, Beddoes, Thornton, 
Blair, and others, a few remarks may first be offered, perhaps with 
some advantage, upon the respective productions of Mr. Hunter 
and of Mr. Bell ; without the least view, however, to disparage the 
intellectual labours and numerous scientific discoveries of the for- 
mer, or the great practical sagacity and eminent professional servi- 
ces of the latter. 

Mr. Hunter, entertaining the opinion that no two morbid actions 

* Johnson's Life of Boerhaave, Works, vol. xii. 

■j- Prselectiones Acad, de Lue Venerea, Prefatio ad Lusini Aphrodisiacum, 
fol Lug. Bat. 1728. 



Sec. IV. IN LUES VENEREA. 1 1 5 

can exist in the system at the same time, maintained that the saluta- 
ry effects of mercury depended upon its producing an action incom- 
patible with that which already existed ; counteracting- the venereal 
irritation by producing another of a different kind. This opinion of 
Mr. Hunter may, at first sight, appear to derive considerable sup- 
port from the method of cure which is generally had recourse to in 
the treatment of some diseases ; as, for instance, the removal of 
glandular obstruction by the influence of calomel on the salivary- 
glands, and the transfer and diminution of a partial inflammation by 
the operation of epispastics. The general law, however, which he 
first devised and employed for the explanation of pathology, that 
two actions cannot be carried on at the same time in the same part, 
or in the same constitution, remains yet to be established, notwith- 
standing the great plausibility with which it has been enforced. 

It is scarcely necessary to remark, that so far as it regards inani- 
mate matter, this principle is altogether inadmissible, as is abund- 
antly proved by the doctrines of projectiles. The history of disea- 
ses also demonstrates that this law is unfounded, and particularly of 
those arising from a specific material. That the human body is 
susceptible of the operation of two distinct contagions at the same 
time has been satisfactorily shown by the facts recorded by Dr. Pa- 
trick Russell, of the small pox and measles which prevailed at Al- 
leppo, in 1765.* On the authority of Bergius and Tandon, men- 
tion is made of several cases in which the measles and small pox 
appeared together in the same individual.! Dr. Willan witnessed 
the occurrence of hooping-cough (a disease of acknowledged spe- 
cific contagion) during the eruption of the small pox in the same 
person ; the formfer disorder remained a long time after the latter 
xvitnoutany material alteration.} Cases of small pox combined with 
measies came under the notice of Dr. Waiker.§ Desessarts men- 
tions the complication of small pox with scarlatina.jj Mr. Leese 
inoculated an infant while labouring under measles, and both diseas- 
es went through their ordinary course.^ Two cases which exhibi- 
ted unequivocal evidence of the possibility of two distinct diseases, 
small pox. and measles, arising at the same period in the human 
constitution, and each preserving its ordinary course as when sepa- 
rately existing, attended with ail their usual characteristic symptoms, 
are recorded by Dr. Tracy.** A number of cases of small pox co- 
existing wita measles, and the two diseases going through their reg- 
ujar stages in the same individuals, occurred at tne Foundiing Hos- 
pital, at Dublin, as appears from extracts from the memoirs ot tne 

* rransl of the Society for the Improv. of Med. and Chirurg". Knowledge, 
vol. 2. 

•[ Ring's Ob serv. on Inoculation; London Med. and Phys. Journal, vol. 14 
p 142. 

t Reports on the Diseases of London, p. 38. 

§ Inquiry m<-o cue Small Fox. See also London Philos. Trans. No. 429> 

U Jo .a- ui de Med. L 49 : London Med. Rev. vol. i. p. 313. 

•f Lond. Med. and Phys. Journ. vol. 4. p. 18. 

** Mitchell and Miller's Med. Bepos. vol. 3. p. 105, 



ll(i OF THE REMEDIES USED Ol. IV, 

Medical Society of that city, communicated by Dr. Rainey.* All 
these instances of the continued operation of measles with other dis- 
orders of specific contagion, it will be proper to bear in recollection, 
are cited from modern authors : the opinions of the more ancient 
writers on this point being disregarded on account of the errors into 
which they were led from adopting the principles of the Arabian 
physicians, and considering and generally treating these different 
specific disorders, small pox, measles, and scarlatina, as modifica- 
tions of the same disease.f 

Mr. Maurice vaccinated two persons who had been previously 
exposed to measles. The vaccine infection and the measles went 
through their usual course at the same time.}: It appears from the 
observations of Dr. Woodville, Dr. Willan, and other writers on 
the cow pox, that if the constitution be submitted simultaneously 
to the action of the small pox and vaccine diseases, that these dis- 
orders go through their course at the same time without influencing 
each other.§ Many cases of this kind might be mentioned. 

In the report of the New-York City Dispensary, published July, 
1809, the physician of the cow pox department, recorded the case 
of a child who, on the eighth day after it was vaccinated, had the 
vaccine disease with all its characteristics, and, at the same time, 
laboured under a" plentiful eruption of small pox," to which dis- 
order it had been exposed by an imprudent visit some days previaus, 
Tne two diseases appeared entirely distinct and independent of each 
other. The physician vaccinated six children from the fluid of the 
vesicle, who all had the regular cow pox, and were afterwards test- 
ed by the small pox inoculation without effect. Several children 
%vere inoculated with the matter from the small pox eruption who 
took the disease in its usual form.|| Dr. Adams himself, the un- 
qualified and indiscriminate panegy ist of the doctrines of Mr. 
Hunter, asserts, that small pox and cow pox " will proceed togeth- 
er in the same person without the smallest interruption to each oth- 
er's course."! Instead, however, of admitting the validity of the 
fact, in opposition to the universal law of Mr. Hunter, Dr. Adams 
declares tnat this circumstance only proves the identity of the two 
morbid poisons. Admirable dexterity of reasoning ! 

If the constitution, imbued with the peculiar matter of any of 
the diseases of specific contagion, or under the action of the vene- 
real virus, were on this account, during the presence of such pe- 
culiar specific matter, not susceptible of the influence of other 

* Duncan's Med. Commentaries, vol. 3. p. 444 ; Macbride's Practice of 
Physic, p. 376. 

f Vide, Sennertus, Med. Pract, vol. 4. cap. xii. Diemerbroeck, Tract, de 
"Varjol. et Morbil. cap. xiv. 

$ Lond. Med. and Phy. Journ. iv. p. 38. 

§ Reports on the Diseases of London, p. 313. Woodville's Reports for a 
series of Inoculations for Variola Vaccinae, p. 145, &c. 

|| Gillespie's Report on the Cow Pox, in Mitchell and Miller's Med. Repos 
▼ol. 13. p. 87. 

1 Observations on Morbid Poisons., 4-to. p. 398. See also his Popular View 
qf Vaccine Inoculation, p. 41. 



SeC. IV- IN LUES VENEREA. 117 

diseases of a specific origin, who would not have observed the in- 
stances of exemption from the operation of contagious and infec- 
tious diseases, and have ascertained and made known so singular 
and specific a cause ? Who is prepared to say, that the individual 
labouring under lues venerea is, on that account, exempt from the 
influence of small pox ; or that he who is infected with small pox 
is. secured from the attacks of plague or yellow fever ? 

The hypothesis of Mr. Hunter, however, whether it be correct 
or not, is irreconcilable with another principle which he himself has 
elsewhere adopted, that the venereal disease often becomes the im- 
mediate cause of other disorders, by calling forth latent tendencies 
into action, as he here admits the concurrence of two distinct ac- 
tions. " I have seen in many cases," says he, " the tendency so ve- 
ry strong, that it has taken place before the -venereal has been entire- 
ly subdued."* But enough has been said to prove the co-existence, 
in the same individual, of diseases essentially different in their pe- 
culiar character, and arising from the operation of distinct specific 
causes. 

Agreeably to the law which Mr. Hunter laid down, the method 
of treatment in the venereal disease is by counter irritation, and to 
excite an irritation greater than that of the venereal. Let this prin- 
ciple be granted as well founded, and it need not here be stated how 
extensive would be the class of anti-venereal remedies. If the sal- 
utary effects of mercury depended upon its producing irritation, 
then other medicines acting as irritants would occasion similar hap- 
py effects. Even fever itself, the effect of irritation, might be of 
the number of anti-syphilitic remedies ; yet, in the treatment of 
lues venerea, it is one of the most common objects of the physician's 
attention to subdue and guard against fever, as well as other sources 
of irritation. But the premises on which this ingenious author pro- 
ceeds cannot be granted. " The removal of venereal action by mer- 
curial action (to quote the language of an able critic) is gradual 
and progressive ; the mercurial must, therefore, exist along with, 
the venereal, until the latter is entirely overcome ; and if these ac= 
tions were not at certain periods co-existent, the cure must be ac- 
complished in a moment, or it could not be accomplished at all. ft 

The theory supported by Mr. Bell, that mercury acts as an anti= 
dote in the cure of the venereal disease, is no less untenable than 
that of Mr. Hunter. The experiment, which he has considered as 
decisive, of the matter of lues venerea on being mixed with tritu 
rated mercury (Plenck's solution) becoming inert, and, consequent- 
ly} incapable of producing disease, can be admitted only as a spe- 
cies of chemical agency upon inorganized materials, and will by no 
means apply to the organized animate body. The assumption that 
such an operation takes place in the human system is altogether 
gratuitous. If, again, the principle just stated were true, that mer- 
cury possesses a peculiar " antidotal" or neutralizing power, simU 
lar to the operation of an alkali upon an acidj the particular activity 

* Hunter on the Venereal, p. 26. 

\ London Med, Review, vol. 1. p. 202 



11H OF THE REMEDIES USED Ch. IV. 

and the advantages which certain preparations of this metal possess, 
might be regarded as of no practical importance, and corrosive sub- 
limate and the crude mineral be employed without distinction: the 
successful treatment of this disease would uniformly depend upon 
the quantity of mercury administered. But this would lead to the 
adoption of a practice at variance with the experience of several 
very eminent writers, and one which Mr. Bell himself thinks pro- 
per to guard against:* and, indeed, the very small quantity of cor- 
rosive sublimate which is necessary to effect a cure, renders it al- 
most certain, as remarked by Dr. Cullen,f that mercury does not 
cure the disease by being an antidote to the poison. The arguments 
in support of this theory, derived from the operation of mercury 
when locally applied, are not to be considered as of any importance ; 
local disease may frequently be changed and effectually cured by 
the application of local remedies. The venereal disease can be re- 
moved by such remedies only as produce a general action upon the 
whole constitution, the medium through which the morbid matter 
is diffused, and upon which it exerts its destructive influence. 

Firstly, In what manner does the poison of specific diseases ope- 
rate upon the human constitution ? and, 

Secondly, What are the changes effected in the system by the in- 
fluence of mercury? 

Little, indeed, is known concerning the peculiar nature of the vi- 
rus of specific diseases: the action which takes place upon the ap- 
plication of the smallest particle of morbific matter to the human 
body, and the process by which it generates disease, converting a lo- 
cal into a general disorder, and thus producing an altered and vi- 
tiated state of the whole system, it must also be admitted, are nei- 
ther very obvious to the senses, nor very clear to the reasoning 
powers of man. The e fleets themselves, however, have been long 
and familiarly known; and from duly considering these, a rational 
theory may, perhaps, be formed of the manner in which they are 
produced. 

That the poison of specific diseases, as that of lues venerea, small 
pox, &c. diffuses itself through the whole constitution, and assim- 
ilates unto its own nature the general mass of circulating fluids, 
seems to be most consonant to all that is understood of their pecu- 
liar character. Upon the introduction of a particle of variolous 
matter into the system, an inflammatory action of the part, into 
which it is inserted, is excited ; by which action new morbific mat- 
ter of the same nature is generated. This process may be carried 
on to a greater or less extent, in a longer or shorter time, in differ- 
ent persons, before the specific material enters the absorbents ; and 
lence local inflammation is, in some cases, considerably advanced 
before the system becomes affected ; while* in others, the eruptive 
symptoms supervene when it appears to have made very little pro- 
gress.! The morbid poison, modified in its action by its degree of 

* Bell on Conor. Will, and Lues Ven. vol. 2. p. 259 

r Cullen's Mat. Med. vol. 2. p. 254. 

t Woodville's Reports on Cow Tox, p. 15. 



SeC. IT. IN LUES VENEREA. 1 1 9 

acrimony, the condition of the part, and habit of body, is taken up 
by the absorbents and enters the blood-vessels ; whence it is receiv- 
ed into the general circulation, and produces its peculiar effects 
upon the constitution. The fluids, therefore, are thus necessarily 
first affected, and, as a consequence of their morbid condition, the 
solids themselves next become vitiated. Hence the multiplication 
of the matter of variolous contagion in inoculated small pox ; and. 
hence, on the same principle, the generation of morbific matter, 
from a similar action, arising from the introduction of other specific 
contagions. 

By the introduction of a specific morbid matter into the body its 
condition is changed from a healthy to a diseased state, the local is 
converted into a general disorder ; the fluids, and ultimately the 
solids, become affected ; and, according to the particular virus in- 
troduced, the whole constitution partakes, in a greater or less de- 
gree, of its peculiar nature, whether it be small pox, lues venerea, 
measles, &c. 

The most satisfactory idea, perhaps, that can be formed of the 
action of morbific poisons on the body, is that of a ferment, or rath- 
er an assimilating- process. That such a process does, in certain 
diseases, take place in the living system has been maintained by 
many of the most distinguished writers. " It is evident," says Dr. 
Cullen, " that the contagion of the small pox is a ferment with re- 
spect to the human fluids, and assimilates a great part of them to 
its own nature/'* " Fermentation," remarks the celebrated Mr. 
Cruickshank, " has been chiefly observed in dead matter, but may 
also take place, and I believe certainly does take place, in living 
matter."! In his observations on the action of variolous contagion 
upon the blood, the most apt idea we can form of it, observes Dr. 
Walker, " is that of a ferment."^ See also the experiments of Sir 
John Pringle,§ and of Dr. Alexander. || 

Mr. Benjamin Bell, though he readily admits that the matter of 
all contagious diseases, and more especially that of lues venerea* 
has a power of assimilating to its own nature a " certain portion, 
and ultimately, perhaps, the whole fluids of the body,"*! canned 
easily suppose how such a process can take place in fluids in mo- 
tion, rest being essentially necessary for promoting fermentation* 
That the matter of certain specific diseases is conveyed through the 
circulating fluids, is abundantly evident from the condition of the 
axillary and other glands in different parts of the body, in small 
pox, lues venerea, Sec. The rapidity with which deleterious and 
other substances are absorbed and taken into the sanguineous circu- 
lation, has been long known, and, lately, satisfactorily shown by the 
interesting experiments, of Deiiie and Magendie.** 

* First Lines, vol. 2. Chap, on the Small Pox, 

■{• Anatomy of the Absorbing Vessels. 

± Liquny into the Small Pox, p. 49. 

§ Diseases of the Army, appendix. 

I! Expenmental Essays, p. 15, &c. 

% Treatise or. Gonor. Viral. .jidLnes Ven. vol. 2. p. 164r 

" Amer. Med and Phil, Kesv?ter. vol. 1. p. 426. 



120 OF THE REMEDIES USED Cb. IY r « 

Were the assimilating or fermentative action confined merely to 
a particular point in the cellular texture, where the specific cause 
was first applied, how would it be practicable to account for the 
generation of new and similar matter in other and distant parts of 
the body, as for the occurrence of confluent small pox after inocu- 
lation. The morbific poison enters the blood, and necessarily com- 
bines with some of its constituent parts ; if so, it must accompany, 
and operate upon, this fluid in its general circulation through the 
system. That this opinion is not hypothetical, but founded on ac- 
curate observation, many established facts might be adduced to 
prove. The effects of the variolous infection on the mother and 
foetus in utero, are capable of explanation upon no other principle 
than that the blood itself is in a morbid state, and assimilated more 
or less unto the nature of the variolous disease. The free and di- 
rect* communication which exists between the mother and child, 
while in the fetal state, will readily be the medium through which 
the matter of specific diseases exerts its operation upon the impreg- 
nated uterus. Dr. George Pearson has recorded many well-authen- 
ticated cases, in which the infection of small pox was communica- 
ted to the unborn infant, and the matter taken from the pustules on 
the foetus, by inoculation infected others.f Two instances of the 
effects of the variolous contagion upon the pregnant mother and 
child occurred in the practice of Dr. Hosack, in 17914 Two strik- 
ing cases of the small pox virus affecting the foetus in utero were 
lately published by Dr. Jenner.§ In the first case the infant sicken- 
ed on the fifth day after birth, and on the seventh well-formed pus- 
tules of small pox appeared : the virus was communicated to oth- 
ers by inoculation. In the second case the child upon birth had ma- 
ny eruptions on it, bearing much the appearance of small pox in the 
early stage of the disease. On the fourth day after birth, « I found,'' 
says Dr. Jenncr, " the eruptions had increased to some thousands, 
perfectly distinct, and their character well marked." " To put the 
matter beyond all doubt," continues Dr. J. " I armed some lancets 
with the virus and produced the small pox by inoculations with it." 
Other facts of a similar nature may be found recorded by Mead, jj 
Ludwigf, Burserius,** Baron Diinsdale,ft Mr. Hunter,|f Hay 
garth,§§ and other distinguished authorities. 

In like manner the circulating fluids may become vitiated and as* 
similated in their nature to the virus of lues venerea. The local 
effects of the disease will appear at different periods in different 
parts of the body, according to their peculiar susceptibility. The 

* MS. Notes on Hosack's Lectures on Pract. of Physic, and on Midwifery. 

i Duncan's Medical Commentaries, vol. 19. p. 213. &c. 

± Duncan's Med. Commen. vol. 19. p. 249. 

§ Med. and Chirurg. Trans, vol. 1. See also Eclectic Repertory, vol. l.p.4. 

|| Discourse on the Small Pox, chap. iv. 

if Adver. Med. Pract. 

** Institutions of the Pract. of Med, vol. 3. 

jj- Treatise on Inoculation 

±+ Philos. Trans, vol. 70. 

§§ On the Small -Pox. 



SeC. IV. IN LUES VENEREA. 121 

foetus in utero may also become affected with the poison of the dis- 
ease, and exhibit symptoms simiiar to those which arise from the 
same cause at other periods of life. The general experience of the 
most eminent practical authors, (with the exception of Mr. Hunter,) 
has so well established the fact that little further need be said at 
present concerning it.* The venereal disease may be communi- 
cated to the foetus in utero, and the healthy child after birth may be- 
come affected with the same disorder by sucking an infected nurse. 
Two remarkable cases, in confirmation of the fact last mentioned, 
occurred in the practice of Dr. Hosack, in the spring of 1S07. A 
healthy infant, born of respectable parents, was placed under the 
care of a wet nurse, and in about four weeks after, eruptions ap- 
peared in different parts of its body. The ordinary alteratives were 
had recourse to without effect : the child became worse ; ulcers on 
the throat and other symptoms strongly resembling those of lues 
venerea were observed. Mercury was now administered in the form 
of the solutio oxymur. hydrargy. by which the disease was com j 
pletely removed: Suspicions being thus confirmed as to the nature 
of the disorder, the infected nurse was dismissed, with an injunc- 
tion to undergo a mercurial course. Shortly after, and regardless 
of advice, she entered into another family in which she again com^ 
municated to a healthy sucking infant the venereal disease, which 
yielded only to the operation of mercury. These two cases render 
it no longer problematical, but unequivocally prove that an infected 
nurse may, merely by her milk, communicate a specific disease to 
her nursling. They also, still further, render valid the opinion, 
that not only the blood but the secretions may, to a certain degree, 
be assimilated in their nature to the virus of certain morbific pois- 
ons. 

It is asserted by the advocates of vascular spasm, that assimila- 
tion is founded on an erroneous and vulgar analogy between a mere- 
ly chemical action and the operation of the animated body ; and it 
has been urged with much force as an objection to the doctrine of a 
fermentative or assimilating process taking place in the living sys- 
tem, that such process is always accompanied with ebullition and 
the extrication of air, phenomena incompatible with the due perform- 
ance of the functions essential to animal existence. Surely those 
who have considered this objection of importance have not attended 
to the ordinary changes which wine undergoes during its secret fer- 
mentation, as it has lately very properly been denominated ; for in 
these changes neither ebullition nor motion is necessary to the fer- 
menting process by which the wine is matured. " Ebullition, or 
any evident motion," observes Mr. Cruickshank, « is not necessa- 
ry to constitute fermentation ; after wine has undergone what is cal- 
led its open fermentation, it continues, after it is bottled, to go 
through its secret fermentation, where no motion is evident, and 
every body knows requires time to ripen." f Even granting that the 
extrication of a portion of air is necessarily, at all times connected 

* Vide Mahon on the Ven. Infect, in Pregnant Women. Lend, Med. Rev, 
ol. 2. p. 44. 

f Anatomy of the Absorbing Vessels. 
VOL. II. 16 



122 ©P THE REMEDIES USED Ch. IV. 

with the assimilating or fermentative process, it forms no argument 
against the principle here advanced : air conveyed slowly into the 
blood vessels is not destructive to animal life, a fact, which the ex- 
periments of Redi, of Florence, and other eminent naturalists have 
fully established.* 

There are two or three other objections urged against the doctrine of 
assimilation which shall be considered rather on account of the high 
authority of their author, than of any weight in themselves. In his 
valuable paper on the origin of contagious and new diseases, Dr. 
Ferriar asks, " docs contagion assimilate all the fluids to its own na- 
ture ?"t The objections which he considers of great force against 
this doctrine arc, that many phenomena in the symptoms and cure of 
fevers point out a spasmodic affection, or diseased action of the ex- 
treme blood vessels as the real cause of fever. In answer to this it 
:may be observed, that the existence of spasm, as essential to the 
character of fever, rests upon the hypothetical views of those who 
•considered diseases as exclusively affecting the solids, a theory, the 
absurdity of which has long ago been pointed out. li This affection 
fa spasmodic affection] is supported," adds Dr. F. " by the action of 
contagion, and, perhaps, is strengthened as more contagion is pro- 
duced/' According to this principle, spasm must be the prominent 
symptom the physician has to subdue in the treatment of contagious 
diseases, and this spasmodic effect will be the more violent in pro- 
portion to the virulence of the particular poison by which it is pro- 
duced. But where arc the facts which warrant conclusions of this 
nature ? Does not the history of contagion uniformly prove its ope- 
ration on the human constitution to be powerfully debilitating and 
depressing, and establish a pathological principle directly the re- 
verse of the one maintained by Dr. Ferriar ? 

Were the fluids infected, observes Dr. F. a patient would not 
cease to infect others till the whole mass was changed. f It is cer- 
tainly matter of surprise that this argument should have been offer- 
ed by a writer who has so long been practically conversant with the 
operation of febrile infection* and who is so fully aware how nume- 
rous are the circumstances which modify the communication of 
contagious disorders. Why the infected body does not, in all sta- 
ges of disease, infect the bodies of others, is a problem, the solu- 
tion of which is no less difficult than why contagious diseases them- 
selves do not uniformly operate upon the constitution of all who 
come within the sphere of their influence. Of the various diseases 
of specific contagion, small pox is justly considered the most viru- 
lent in its nature and the most universal in its operation: yet the 
many cases of exemption from the action of variolous contagion, 
particularly of those recorded by Dr. Lind,§ will assuredly not lead 
to the absurdity of denying the specific character of the disease, and 
that it is propagated by contagion. 

* Redi, vol. 4. p. 223. as quoted by Sir John Pringle ; Diseases of the Army. 
Appendix, paper vii. 

| Med. Hist, and Reflect, vol. 1. p. 280. 2d. ed. 
± Med. Hist, and Reflect, loc. tit. p. 281. 
§ Papers on Contagion and Infection , 



8eC IV. IN LUES VENEREA* 123 

Judging from the following passage, which occurs in the essay* 
from which the preceding quotations have been made, it would 
seem that Dr. Ferriar is by no means convinced of the soundness of 
his own reasoning. He here appears the decided advocate of the 
very principle which he elsewhere opposes. " It is peculiar to the 
animal poisons," says he, •" that they not only give rise to a disease 
similar to their original, but that, however small the quantity ap- 
plied, they convert a large portion of the Jluids to their oivn na* 
ture"* 

Analogical proof in support of the doctrine of assimilation might 
be adduced from considering the changes which the different articles 
of food uncleigo when converted into chyle; but the facts already- 
advanced render, in the opinion of the writer, the existence of such 
a process no longer controvertible. 

It appears, therefore, from the changes which take place in the 
healthy constitution upon the introduction of the peculiar virus of 
lues venerea, small pox, measles, and other diseases of specific 
contagion, and from the nature of the alteration which is thereby 
effected; from the conversion of a local affection into a general dis- 
order, and the multiplication of the particular morbific matter 
throughout the system ; from the communication in all cases of the 
same specific disease, by inoculation, through the medium of the> 
general circulation, and by the secretions, and from other phenom- 
ena which characterise these disorders, that the fluids of the human 
body are susceptible of material alteration even in the living states 
that this alteration uniformly partakes of the nature of the morbific 
matter introduced; that the materies morbi thus generated is alone 
capable of propagating a disease in another constitution, in all re- 
spects of the same character, and none other ; in fine, that the circu- 
lating mass of the system does become assimilated in its nature to 
the virus of specific or contagious diseases, and, as a consequence, 
that the solids themselves also become affected. For such is th© 
general law of the animal economy, modified by the living principle, 
that the action of one part is subservient to that of the other ; while 
they regularly harmonize in health, they all are acted upon by dis- 
ease. It has justly been observed, ki an exclusive theory, either of 
solidism or humorism, is a solecism in pathology." 

As this alteration in the healthy state of the system, which fol- 
lows upon the operation of the virus of diseases of specific conta- 
gion, is characterized by a regular and peculiar train of phenomena, 
from observing these effects thus constantly produced, many at- 
tempts have been made to ascertain the particular cause. The ex^ 
planation which has just been offered, seems to convey the most ac- 
curate idea of the kind of action which takes place ; that the spe- 
cific matter of these diseases acts as ^ferment, and by the process 
consequent thereon, assimilates the system to their own peculiar 
nature. Doubtless this process is more or -less governed by the liv- 
ing principle ; and as chemical writers have observed different spe- 
cies of fermentation in inanimate materials, so also pathologists will 

* Med, Hist, and Reflect- ioa, cit. p. 278. 



32 i OF THE REMEDIES USED Ch. IT 

admit a modification of the same action when occurring in living or- 
ganized matter. " All that is necessary in fermentation," says an 
able philosopher already referred to, " is, that the elementary par- 
ticles be separated and recombined, so that the matter be converted 
into something different from what it was before."* From the re- 
futation that has been given of the chief objections to this theory, the 
reader will have already understood the principles upon which it 
rests. 

Secondly. With regard to the changes effected in the system by 
the influence of mercury. 

Mercury in the state of an oxide, is one of the most universal 
stimulants. Its action, though primarily on the nervous system, is 
communicated to every fibre of the body, and produces a degree of 
restlessness, anxiety, and debility. When taken into the system, it 
manifests itself by a quickened circulation, gives the blood the dis- 
position to take on the buffy coat when drawn, renders the pulse 
frequent and harder, increases respiration, excites the temperature 
of the body, occasions a whitish fur on the tongue, and other symp- 
toms of general inflammatory action. Its effects upon the secre- 
tions are still more apparent, producing a preternatural flow of sal- 
iva, an increased action of the mucous vessels of the trachea, lungs, 
digestive organs, chylopoietic viscera, and whole intestinal canal. 
It excites a copious discharge of urine, and in the smallest quantity 
operates with great certainty on the skin. In its thus extensive in- 
fluence on the body, it produces a consequently increased action of 
the absorbent vessels. These may be considered the more ordinary 
sensible effects of mercury when its action is not particularly mod- 
ified by the morbid condition of the constitution. 

From the very general and stimulant operation of mercury in pro- 
moting the excretions of the whole system depends its curative ac- 
tion. This theory of the manner in which mercury produces its 
salutary effects, was suggested in the lectures on the materia medi- 
ca formerly delivered by the present professor of the theory and 
practice of physic in the University of New-York.f It appears to 
be deduced from the nature of the changes which this powerful 
remedy uniformly effects, when its action is not interrupted or 
changed by adventitious circumstances; and believing it calculated 
to lead to material improvement in practice, in addition to the facts 
and reasonings with which it was originally enforced, the writer now 
offers such others as seem still stronger to confirm its correctness. 

It may be asserted as a fact fully confirmed by modern observation 
and experience, notwithstanding the general opinion of the older 
writers to the contrary, that the curative operation of mercury, in 
lues venerea, depends upon the action which it produces through- 
out the general system : that its sanative powers are in proportion 
to its uniform effects upon all the secretions, and that the advanta- 
ges which certain preparations of this mineral possess over those 
of others, are ascribable chiefly to their action not being confined 

* Cruickshank's Anatomy of the Absorbing- Vessels, 
f Doctor David Hosack. 



SeC. 1Y. IN LUES VENEREA. 3 25 

to the increase of the salivary discharge. In proportion also as the 
action of mercury is general throughout the system, its tendency 
to run off by any particular secretion is diminished ; and, vice versa, 
the excitement and consequent increase given to any one secretion 
almost uniformly produces a diminution of every other. 

Admitting these principles to be well founded, it follows that the 
same salutary effects will not be experienced when the operation of 
mercury is exclusively directed to the salivary glands, or when it 
exerts its influence on the intestinal canal alone. Hence, in the ad- 
ministration of this remedy, in lues venerea, in order most effectu- 
ally to obtain its full operation, it must be introduced into the sys- 
tem in a gradual manner : as it is equally the physician's care to 
guard against an undue augmentation of the salivary discharge, as 
well as a preternatural increase of the evacuation by the bowels : 
for, in the former case, by promoting a salivation, the important 
functions of the skin and other secretions are lessened or suppres- 
sed ; and, in the latter case, the remedy is prevented from entering 
into the general system in proper quantity. That the medical vir- 
tues of mercury depend principally upon its operation on the exha- 
lent vessels of the general surface, at the same time that it operates 
upon the other emunctories of the body, is still farther evinced by 
the superior benefit which is derived from certain preparations cf 
this metal which are known to act almost exclusively in producing 
diaphoresis ; as the combinations of it with the marine acid in the 
form of the corrosive sublimate. Proofs of a like nature may be 
drawn from the action cf those remedies which are often united with 
mercury, for the more advantageous treatment of the venereal dis- 
ease, as antimony, gv.aicum, sarsaparilla, opium, Sec. Again ; ex- 
perience has uniformly shown, that if the action of mercury in cau- 
sing diaphoresis be aided by a proper regard to temperature, food ? 
and regimen, and such means as operate upon the skin, its salutary 
effects are greatly increased : and if its operation be prevented or 
suppressed by irregularities in diet, or from exposure to cold, they 
are greatly diminished. 

This view of the operation of mercury appears still more clear 
and satisfactory from considering the inlluence of climate in the re- 
moval of lues venerea. How mild and tractable even the most ob- 
stinate and confirmed cases of syphilis become upon the patient's 
removal to a temperate latitude is familiarly known. Not that the 
air of Montpelier, of Italy, or of Portugal, possesses, in itself, 
any peculiar balsamic influence, but that the effect of a tempera- 
ture, such as these places boast, is calculated to insure the full 
operation of mercury upon all the emunctories of the body, and to 
prevent its partial influence on any particular part. In temperate 
climates salivation is at all times studiously guarded against, not 
less than the pernicious effects which would arise from the inordi- 
nate action of the medicine upon the intestinal canal ; and if, while 
in the employment of mercurial remedies, the least symptom of 
such effects appears, the use of those remedies is immediately sus- 
pended. To restore the tonic powers of the system, if impaired, 
previous to entering upon the use of mercury, and to support them 



126 OF THE REMEDIES USED Clj. IV, 

while under its action, are the principal indications of cure ; by 
these means the constitution is enabled to undergo the necessary al- 
teration, mercury exerts its natural operation, the venereal poison 
is eliminated, and a radical cure is effected. Those disposed to en« 
ter more fully into a consideration of the salutary effects of a tem- 
perate climate, Sec. in aiding the general operation of mercury, as 
an anti-venereal, will find the opinions of Mr. Hunter,* on this sub- 
ject, completely overthrown by the facts recorded in Harris,! Don 
Uiloa4 CJark,§ Moseley,|j Swediaur,^[ and Vage.** Availing him- 
self of a knowledge of the importance of a warm climate in mitiga- 
ting the severity of venereal affections, the practical physician, as 
Dr. Swediaur has justly observed, " will be able to put his patient, 
in any country whatever, in a situation which he finds necessary for 
curing this complaint." By keeping him in a mild and uniform 
temperature, by the occasional use of warm bathing, by enjoining 
the wearing of flannel, and proper attention to regimen and diet, a 
substitute not less efficacious than " climate" is obtained, which 
eminently contributes to the operation of mercury 'in eradicating 
the virus of the disease from the system. 

It is not at all contended for in this place, that mercury induces a 
peculiar morbid state of the fluids, such as some of the other au- 
thors denominated dissolved, and which a late writer of the same 
school, Mr Howard, terms a " putridity sui generis,"f f and that 
in this manner it throws out offensive matter and effects its salutary 
ends; but inasmuch as it produces a quickened action of the blood 
vessels, and a consequent increase of all the secretions, it may 
justly be considered a most powerful alterative ; and as it possesses 
in a special degree the property of exciting the excretory vessels 
of the skin, intestinal canal, and kidneys, it arrests the progress of 
that peculiar operation which, it has been maintained, takes place, 
Upon the absorption of a specific matter into the system, and which, 
as has already been observed, has significantly been termed by sev- 
eral practical writers the assimilating process. 

In the treatment of the diseases universally acknowledged to arise 
From s/ieci/ic contagion, mercury has at length become an active 
constituent in almost all the various articles employed for that pur- 
pose, and there is every reason to believe that the evils resulting 
from such practice have greatly counterbalanced the advantages, 
But the consideration of one only of the diseases belonging to this 
class can here be attempted. Notwithstanding all that has been 
written, so ill defined are the diagnostic signs of lues venerea, whe- 
ther it assumes the form of a local affection, or operates more im- 
mediately on the whole system ; so various and complicated are its 

* Treatise on the Venereal Disease, 4to. p. 348 — 9. 

f Collection of Voyages and Travels, fol. vol. 2. p- 5M 

t Voyages to South America, vol. 1. p. 280. 

§ Diseases of Long Voyages, vol. 2. p. 440. 

!| Treatise on Tropical Diseases, p. 76, 4th ed 

^1 Pract. Observ. on Ven. Complaints, p. 167 

** London Med. and Phys. Journal. 

H" See hi<? Observ. on Ycv His; Lond. 1S06 



Sec. IV. IN LUES "VENEREA. 127 

symptoms in its different stages, and so uncertain its course and 
.crmination, that there are few complaints which require a more 
intimate knowledge of their nature in order to effect a radical cure ; 
and it may well be questioned, whether the mal-administration cf 
the remedy has not produced as destructive consequences as the dis- 
ease itself. The practical observer will recollect how numerous 
are the diseases arising from causes essentially different from that 
which gives origin to the venereai, ye'e, nevertheless, in their char- 
acters bearing an exact resemblance to it; that the venereal not un- 
frequemly exists in combination with other disorders; and that from 
errors in the mode of treatment, not only its nature may become 
altogether changed, but diseases equally formidable be brought on. 

The existence of diseases of the first kind, " wearing the livery*'' 
of lues venerea, did not escape the acute penetration of Mr. Hun- 
ter ; and the subsequent labours cf Mr. Abernethy have more ful- 
ly disclosed their perplexing nature. But as there are no discrim- 
inating marks by which they may be distinguished, there is yet no 
general rule of practice established. The effects of mercury upon 
them are various. According to Mr. Abernethy, they are some- 
times cured by it, sometimes they are only checked, and at ether 
times aggravated.* This, however, is certain, that mercury may 
be misapplied in the treatment of these anomalous cases ; and the 
practical caution of Mr. Hunter is not to be forgotten ; that " it is 
nearly as dangerous in many constitutions, to give mercury where 
the disease is not venereal, as to omit it in those which are."f In 
the diseases of the second kind, it is equally well known, after the 
removal cf the specific infection for which recourse was had to mer- 
cury, that the other symptoms under which the patient may labour 
are so deceptive, as frequently to be enumerated among the secon- 
dary effects of the venereal, and instead of yielding to the power of 
the same remedy, become more alarming-, and if its use be persist- 
ed in, terminate fatally- And as far as relates to the cure of the 
disease, those most conversant with it have furnished sufficient proofs 
of the pernicious consequences attendant upon errors in its treat- 
ment.! 

Of these errors the common, and probably the most destructive. 
is the inducing of profuse salivation, which is generally brought en 
by throwing into the system large quantities of mercury. To do 
this in the shortest possible time is the immediate object, and calo- 
mel pills, or some other form of mercury, is taken internally, and 
mercurial unguents or frictions employed. The evident result cf 
such practice cannot fail to be injurious to the constitution. When 
this discharge is thus excited, it often continues until a total ex- 

* Surgical Observations, part 2, on diseases resembling Syphilis. 

•j- Treatise on the Yen. lhs. p. 381. 

i See the respective publications of Hunter, Bell, Swediaur, and Howard, 
on the Venereal. Pearson on the effect of various articles in the cure of Lues 
Venerea. Alley's Observ. on Hydrargyria. Spens' Cases of Erythema Mercu- 
riale, Ed. Med. and Surg. Journal, vol. 1. p. 1. M'MulLn on the Erythema 
Mercuriale, Ed. Med. and Surg. Journal, vol. 2. p. 25. Willan on the Diseases 
of the Skin, and Mathias on the Mercurial Disease. 



128 OF THE REMEDIES USED Ch. IV. 

haustion of the strength of the patient is the result. In many ca- 
ses, where it has been thought to have removed the disease, it has 
proved to be only a temporary cessation of its action ; and in other 
instances, it has converted a comparatively mild disorder into one 
infinitely more dangerous. 

As the venereal arises from the introduction of a specific morbid 
matter into the system, so the peculiar action of this matter consti- 
tutes the disease. The particular manner in which it produces the 
various changes from a healthy to a diseased state, in which there 
exists, in a greater or less degree, an altered and vitiated condition 
of the fluids, from which source all parts of the body may be affect- 
ed, is explicable by having recourse to the idea of a ferment, or an 
assimilating process, as most consonant with the phenomena which 
accompany the operation of the specific matter of lues venerea. 
The poison of disease is taken up by the absorbents, the local be- 
comes a general affection in a longer or shorter time, according to 
the virulence of the matter and the susceptibility of the constitution. 

Enough, however, has been said to prove that in the treatment 
of lues venerea such remedies are to be employed as operate more 
directly in promoting the action of all the secretory vessels of the 
body, and especially those of the surface ; because, as before stated, 
by this action the morbid process which has taken place will be ar- 
rested, and the assimilated matter carried out of the body. Equal- 
ly opposed, therefore, to the opinion declared by Mr. Bell, that " no 
advantage is derived from any increase that may be made to any of 
the secretions,"* and to that of Mr. Howard, who is the advocate 
for profuse salivation, even in the mildest form of the disease, and 
who contends, that the greater the discharge the more certain the 
eure,f the truth lies between them, and the most certain and effect- 
ual practice depends upon an increased discharge from the excreto- 
ry -vessels of the whole system. 

To render plain truths still plainer, and to show, on this subject, 
more strikingly the incorrectness of Mr. Bell and of Mr. Howard, 
let it be recollected, that the effect of every preparation of mercu- 
ry is uniformly evinced by a greater discharge of some of the secre- 
tions ; and this effect is so constant, that it sometimes takes place 
from the use of the mineral in a crude state. :{: In short, as Mr. 
Hunter remarks, there is no proof of its affecting the constitution 
without this consequence ; and its employment assuredly cannot ^be 
followed by any salutary result, unless it operates upon the consti- 
tution. But it is useless to dwell on this point, and there are prob- 
ably few men of observation who will accede to the sentiment ex- 
pressed by Mr. Bell. The opinion stated by Mr. Howard, of the 
necessity of profuse salivation in every case, had its advocates at a 
very early period in the history of this medicine, and though per- 
haps scarcely any opinion has at different times been more warmly 
embraced, or more indignantly rejected, it nevertheless at the pre- 
sent day is unfortunately one of the most popular. The older prac- 

* Treatise on Gonor. Vir. and Lues Yen. vol. 2- p. 272. 
f Observations on the Venereal Disease, vol. 1. p. 297. 

* Mead's Medical Works, vol. 1. p. 106. 



S€C. IV, IN LUES VENEREA. 129 

titioners attempted to justify this absurd and destructive method of 
treatment, by maintaining that salivation melted down and carried 
away the serum of the blood which contained all the venom of the 
venereal disease. At the present time, the practice of exciting 
salivation seems to owe its general reception to the well-known 
principle espoused by Mr. Hunter, that no two morbid actions can 
exist at the same time, and that one irritation destroys another. 
And yet nothing can be more evident, from Mr. Hunter's writings, 
than that this very method of cure met in him a decided enemy. 

It is of minor consideration to be informed of the causes which 
have given origin to this mode of treatment ; and painful indeed 
is the recollection of the miseries it has created. No absurdity in 
medical practice has been the destruction of more lives ; none the 
source of more pain and calamity. Well might Dr. Hoffman pro- 
nounce the abuse of this remedy, in the hands of the unskilful, to 
be more terrible than the sword. Peritiores non sine ratione mer- 
curialia in heroicorum remediorum numerum retuierunt, eo quod 
ejus indolis ac virtutis sint, ut eorum providus usus valde prodesse, 
abusus vero validissime nocere possit, ideoque in manu im/ieriti tan- 
guam gladius in manu furiosi sint.* The pages of the older writers, 
as well as those oi the modern, fully confirm the fact. Yet this 
method of cure is still /wfiular, still pursued both in private practice 
and in public institutions. 

From the theory which has already been given of the nature and 
character of lues venerea, the whole system is the seat of the dis- 
ease, and the indications of cure will accordingly be more readily 
fulfilled by the employment of those remedies which attack the dis- 
order by their operation on the whole system. Of the various rem- 
edies calculated to obtain this end, mercury possesses superior 
claims, and those preparations of it which more directly act upon 
the secretory vessels of the surface, for the reasons before mention- 
ed, are to be preferred. A preternatural action of any one of the 
secretions is not to be depended on, as « it is only a proof of the 
susceptibility of some parts to such a stimulus,"! and the disease 
will remain uncured, as is shown from the stationary appearance of 
local affections.^ By topical applications, too, local affections may 
assume the healthy character, and yet the constitution remain con- 
taminated. Mercury, therefore, to employ the forcible language 
of Mr. Hunter, must be in a state of solution in the juices of the 
body. 

The importance of this method of treatment in confirmed syphi- 
litic cases cannot be too strongly kept in mind ; as from a disregard 
to this principle in the employment of mercurial remedies, are to 
be traced most of the evils arising from the abuse of mercury; and, 
perhaps, a majority of the instances of failure in effecting the per- 
manent removal of syphilis, are to be attributed to the same cause, 
Were the gums alone the seat of the venereal virus, the reasoning 

* Med. Rational. System, vol. 2. p. 257- 

-j- Hunter on Lues Ven. p. 344. See also Ferriar, Med. Hist, and Inflect, 
vol. 3. p. 257. 

t Hunter, p. 341, Saunders on the Liver, 4th ed. Appendix, p. 7?,. 
VOL.H. 17 



13# ©P THE REMEDIES USED Gil. IV. 

of those who contend for the exclusive action of mercury on the sa- 
livary glands might be admitted as satisfactory. Few, however, if 
any, have been the abettors of so absurd an hypothesis, though it 
affords the only possible ground upon which they can attempt to jus- 
tify their loathsome and pernicious practice. Wiseman, in his Trea- 
tise on the Lues Venerea, has ably exposed some of the principal 
errors in the management of syphilis, committed by the practition- 
ers of his time ;* and more lately, Dease, in his Observations, has 
placed in a striking light the pernicious effects of the « hot salivat- 
ing method of cure." The following paragraph, from the pen of 
Mr. Dease, happily describes the plan of treatment formerly much 
pursued. It probably has been the lot of the reader to witness a 
similar practice, not unfrequently followed at the present day, and, 
singular as it may seem, still recommended with all the weight of 
professorial authority. " In a confirmed syphilis,'* says Mr. D. « the 
hot salivating .method of treatment was adopted ; the patient was 
crammed into a narrow room, heated with a stove if it could be pro- 
cured, the admittance of any fresh air was shut out by blankets put 
up to the door and windows, and a screen surrounded the patient. 
There he sat, half suffocated in his own hot, putrid atmosphere, 
and was rubbed with mercurial ointment until his tongue generally 
lolled out ; the inside of his mouth was covered over with sloughs." 
" In this hideous pickle," continues Mr. D. « he was to lie for twen- 
ty-five or thirty days."f That numerous were the victims to this 
empirical plan of cure will not excite surprise." 

* Cbirurgical Treatises : viii. on Lues Ven. vol. 2. 

j" Observ. on the different methods of treating the Yen. Dis. Dublin, 1779. 

IV. Of the Preparations of Mercury. 

We have already had occasion to observe that crude 
mercury is not soluble in any of the fluids which it 
usually meets with in the human body ; and as no ef- 
fects result from it while it remains in this insoluble 
slate it has been considered as a very important object 
to prepare it in such a manner that it may with most 
ease and safety be introduced into the system in a so- 
luble form. It unfortunately happens, however, that 
all the active preparations of mercury, I mean such 
as prove effectual in curing the venereal disease, are 
apt to excite very disagreeable symptoms, particularly 
salivation to a distressful height, purging, and general 
debility. Scarcely any point in practice has therefore 
met with more attention than the different methods of 
exhibiting mercury. Regular practitioners have in all 
countries been anxious to render mercury at the same 



SeC. IV. IN IUES VENEREA. 131 

lime active and safe, while it has been the pride of ev- 
ery empirick to be able to boast of some new discove- 
ry by which this remedy may be given with freedom 
and safety without being deprived of its essential 
properties. 

The preparations of mercury are accordingly very 
numerous: upwards of five hundred might be enu- 
merated. The consequence of which is, that much 
doubt and uncertainty has taken place concerning 
them ; for while one preparation has been in common 
use with some practitioners, we find it entirely neg- 
lected by others ; and in some countries preparations 
of mercury are employed daily which in others are 
very generally condemned. 

This would lead to the conclusion of our being able 
to cure the disease with perhaps equal ease and safety 
with a great variety of these preparations, and this I 
believe to be in some measure the case. We are very 
apt to fall into a routine of practice, from which it is 
with some difficulty that we emerge, and which there- 
fore every practitioner ought early in life to guard 
against. In no instance is the want of attention to this 
more conspicuous than in our practice in Lues Vene- 
rea, where the same practitioner very commonly per- 
sists in the same method of exhibiting mercury, and is 
therefore soon induced to suppose that no other is 
equal to it, whereas were he to make trial of others he 
would find many by which the disease can be cured 
with equal ease, expedition, and certainty. To enu- 
merate all the preparations of mercury that have been 
employed could answer no good purpose; and being 
unnecessary, the attempt would be improper. I shall 
shortly mention, however, ail such as are in general 
use, with the views which practitioners have in giving 
a preference of one to the other. 

It is found by experience that mercury may be ren- 
dered soluble, so as to prove active when received 
into the system, by three different processes; by tritu- 
ration; by calcination ; and by solution in a variety 
of acids, 



532 OF THE REMEDIES USED Ch. IT; 

Whether any property is communicated by any of 
these processes to mercury which it did not before pos- 
sess it may be difficult to determine. It would appear 
that they render mercury active nearly in proportion 
to the degree of solubility which they give to it; and 
this again seems to depend in a great measure upon 
the degree of separation produced by these processes 
between the different particles of the mercury : At 
least this is clearly the effect of trituration. We have 
seen that in a crude state this metal is altogether in- 
ert ; and we find by experience that it proves active 
in proportion to the trituration employed upon it ; 
and as by calcination and solution it is rendered still 
more active than it can be made by triture alone, 
we conclude that these processes are better calcu- 
lated for producing a more complete division of its 
particles. 

By agitation alone mercury may be reduced to the 
state of a powder, as was first attempted by Doctor 
Boerhaave, and afterwards by the very ingenious 
Doctor Saunders of London ; but the length of time 
required for this being very considerable, practition- 
ers have been accustomed to triturate the mercury 
ivith such substances as tend more effectually to keep 
the particles of the metal separate from each other, 
by which, while the virtue of the medicine is not les- 
sened, the process for obtaining it is much shortened, 
This, accordingly, is the foundation of various active 
preparations of mercury, of which the following are 
in most frequent use. 

I. Where the mercury is triturated with unctuous 
substances, and used externally only, as is the case in 
the emplastrum hydrargyri of the London and Edin- 
burgh dispensatories, and in the unguentum hydrar- 
gyri vel mercuriale. 

* II. Where it is tritured with gums, mucilages, and 
saccharine substances, and chiefly employed for in- 
ternal use, as in the pilul&B hydrargyri. Pharm. Lond* 
and Edin.; in the solutio mercurialis gummosa of 
Plenck ; in the injectio mercurialis • and mel mercu- 
riale. 



Sec. IV. IN LUES VENEREA, 133 

III. Where it is tritured with dry calcarous pow- 
ders, such as crabs eyes, and prepared chalk, forming 
what is usually termed mercurius alkalisatus/* 

Besides these mercury might be tritured with sever- 
al other substances with perhaps equal advantage. 
Sulphur alone seems to render it inert or nearly so, 
The more friction that is employed upon mercury 
mixed with any other substance the more active it be- 
comes, while the more that it is rubbed with sulphur 
the more inert it is rendered. 

A very active preparation of mercury is obtained 
by means of heat ; it is termed mercurius calcinatus, 
and is the basis of different pills and powders. In this 
process the mercury is reduced to a calx by long ex- 
posure to a very considerable degree of heat. 

Mercury is found to be more or less soluble in eve- 
ry acid, and the calx or salt obtained from these solu- 
tions gives the most active form of the remedy with 
which we are acquainted. 

1st, Mercury combined with the muriatic acid gives, 
by different processes, the mercurius sublimatus cor- 
rosivus, orhydrargyrus muriatus corrosivus; and mer- 
curius dulcis, calomel, or hydrargyria muriatis mitis; 
from the first of which are prepared the solulio mer- 
curii spirituosa of Van Swieten ; the aqua phagadeni- 
ca and other watery solutions of corrosive sublimate 
of different authors, and pilulae e mereurio corrosive. 
From the latter, viz. mercurius dulcis, are prepared 
a variety of active formulae both for internal and ex- 
ternal use ; but these differing only in the vehicles by 
which they are conveyed it is not necessary to enu- 
merate them here. 

2dly, With the acid of nitre, from which is prepar- 
ed mercurius precipitatus ruber, the basis of various 
external applications ', ungentum hydrargyri nitrati 
mitius, vel ungentum citrinum ; and the pulvis mer- 
cuni cinereus. 

* Prescriptions for each of these, as well as for the preparation of every 
rtther article which I shall have occasion to mention, will be given in the 

Appendix, 



134 OF THE REMEDIES USED €ll. IV. 

3dly, With the vitriolic acid, with which we prepare 
turpethum minerale. 

4thly With the acid of vinegar, from which is pre- 
pared Keyser's pills; analogous to which is the terre 
feuillete mercurielle of Preslavin, prepared with mer- 
cury dissolved in the acid of tartar. 

Mercury has also been dissolved in the acids of lem- 
ons, sugar, borax, arsenic, and spar ; and in a great- 
er or lesser degree it is soluble, as I have already ob- 
served, in perhaps every acid ; but as every useful 
purpose of the medicine may be obtained from one 
or other of the foregoing forms, it appears to be un- 
necessary to enumerate more, particularly, as those 
who wish for farther information will readily obtain it 
in the various Dispensatories published in different 
parts of Europe. 

It may here be proper to remark, that although all 
of these preparations are in appearance different from 
each other, yet all of them seem to have nearly the 
same effect upon the mercury. They tend all to reduce 
it to the form of a calx, and in proportion as the cal- 
cination is completely accomplished the medicine be- 
comes active or otherwise. Even the trituration of 
mercury has the effect of reducing it to the slate of a 
calx, and it is obviously in this manner that it is acted 
upon by acids ; for when dissolved in acids, and the so- 
lution evaporated, nothing but a pure calx is observed 
to remain. 

But all hough all of these preparations of mercury 
seem to be more or less active according as the calx. 
Avhich they produce is more or less perfect, there is how- 
ever some manifest difference in the calces obtained 
from them. All of them produce the distinguishing 
characteristics of mercury upon the system : they 
cure the venereal disease, and they excite salivation ;. 
but this is done much more easily, and with less 
distress in the operation, by some of these than by 
others. 

Of all the preparations of mercury those produced 
hy triture alone seem to be the best for general use. 
Thev cure the venereal disease with the same cer- 



j Sec. IV. IN LUES VENEREA. 135 

| tainty as the others, and they are not so apt to affect 
the stomach and bowels ; although the saline prepara- 
tions of mercury, when the acid with which they are 
combined is completely separated from them, may, 
under proper management, be given with perfect safety, 
and wit! equal certainty of curing the disease. Corro- 
sive sublimate mercury, as it is termed, is one of the 
most acrid of all the mercurial calces,* insomuch that 
scarcely any person can bear it in the dose of a grain, 
and in the quantity of a very few grains it acts as a pri- 
son ; but even this very acrid remedy is rendered so 
mild by being deprived of the acid with which the 
mercury is united, that in the form of calomel it may 
with safety be given to the extent of several grains at 
once.f We find also that the saline calces of mercury 
prove in some degree acrid in proportion to the 
strength of the acid with which they are combined : 
hence all the combinations of mercury with the mu- 
riatic acid, with the acid of nitre, and the vitriolic 
acid, prove much more acrid than the calces obtained 
from mercury united with the acetous acid, or acid of 
tartar. It is therefore probable that if these prepara- 
tions of mercury could be entirely deprived of their 
saline combinations, that they would not differ in any 
material point from the preparations obtained of this 
metal by triture. 

As yet however we have not been able by any pro- 
cess to which they have been subjected, to prevent 
them from operating very differently upon the human 
body, according to the kind of acid with which they 
are prepared, Thus, while simple triturated mercury 
acts chiefly upon the salivary glands, mercurius subli- 
matus corrosivus is more apt to act as a diaphoretic, and 
it readily excites nausea and vomiting. The same 
preparation again, when more completely deprived 
of its acid, does not seem to affect the skin, nor in 
small doses does it so readily injure the stomach, while 
it acts with more certainty as a purgative. Indeed 
calomel, in proper doses, is perhaps one of our surest 

* Vide Appendix, No. 8- + Vide No. 9. 



136 OF THE REMEDIES USED Cll. TV. 

purgatives; and in order to act upon the salivary 
glands it must either be given in small doses, frequent- 
ly repeated, or combined with opium or some other 
astringent. The mercurius cinereus is also apt to af- 
fect the bowels, while the combination of mercury 
with the vitriolic acid in the form of Turbeth's miner- 
al, or hydrargyrus vitriolatus flavus, chiefly operates 
upon the stomach. 

It is proper that in practice these different actions of 
the preparations of mercury should be kept in view ; 
for although all of them, as I have observed already, 
will, under proper management, cure the venereal 
disease, some advantage is occasionally obtained from 
adapting them as much as possible to the nature of the 
symptoms for which they are intended. Thus, when 
a mercurial emetic is wished for, we give Turbeth's 
mineral ; calomel is always given as a mercurial pur- 
gative ; and in particular affections of the skin corro- 
sive sublimate appears in some instances to succeed 
where other preparations of mercury have failed. 



We add to the present section, a list of the various preparations 
of mercury mentioned above with their syncnimes, according to the 
nomenclature of the Edinburgh and London Pharmacopeias. The 
old names used by Mr. Bell are placed first in order. 

Mercurius Mkalisatus. Hydrargyrus cum Creta (Lond.) Quick- 
silver with Chalk. 

Mercurius Calcinatus. Red oxyd of Quicksilver (Lond.) 

Hydrargyrus Muriatus corrosivus. Oxymurias Hydrargyri. 
Oxymuriate of Mercury. Corrosive Sublimate. 

Hydrargyrus muriatus mitis. Murias Hydrargyri. (See Mur- 
ray's Materia Medica, p. 346.) Muriate of Mercury. Calomel. 

Mercurius fir ecifiitatus ruber. Red oxyd of Quicksilver by Ni- 
tric acid, (Edin.) Sub Nitrate of Mercury. Red Precipitate. Red 
Nitrated Quicksilver, (Lond.) 

Pulvis Mercurii Cinereus. Ash coloured oxyd of Quicksilver, 
(Edin.) 

Turftethwn Minerale. Yellow Sub-Sulphate of Quicksilver, 
(Edin.) Hydrargyrus Vitriolatus, (Lond.) Turbeth Mineral. Hy- 
drargyrus vitriolatus flavus. 

Hydrargyrus Acetatus. Acetite of Quicksilver, (Edin.) 

Hydrargyrus cum Sulfihure. Black sulphuret of Quicksilver, 
(Edin.) iEthiops Mineral. 

Cinvabar. Red Sulnhuretted Quicksilver. (Lord.) 

Ed. 



geC. IV. OF LUES VENEREA. 137 

V. Of the different Methods of exhibiting Mercury. 

In the cure of Lues Venerea, mercury, in every 
form, acts either locally upon particular systems or it 
enters the system and cures the disease of the consti- 
tution. We shall afterwards have occasion to speak 
more particularly of the treatment of local affections ; 
at present we shall attend chiefly to the different me- 
thods of throwing mercury into the system. 

Three different methods have been employed for 
exhibiting mercury ; by conveying it in the form of 
fumes; by taking one or other of the preparations of 
mercury into the stomach ; and by applying them to 
the surface of the body. 

The fumes of mercury are applied to the body 
by burning different mercurial calces in the patient's 
chamber. By thus breathing, as it were, a mercurial 
atmosphere, and having the fumes equally applied to 
every part of the surface of the body, the usual ef- 
fects of mercury upon the system are soon produced, 
more quickly perhaps than by any other method. Cin- 
nabar is commonly employed for this purpose ; but 
Turpethfs mineral, with the addition of sulphur, and 
JEthiop's mineral, answers equally welL 

Where it is m*ant to raise a salivation suddenly, or 
to throw mercury quickly into the system, this is per- 
haps the surest method of doing it ; for with the fumes 
of mercury a salivation is sometimes excited in the 
course of a few hours. This brought the practice in- 
to much reputation when salivation alone was con- 
sidered as the chief part of the cure ; but now when 
it is known that Lues Venerea may be cured without 
much salivation being excited ; that the more gradual- 
ly mercury is thrown into the system the more effec- 
tually it operates; and that very violent effects are 
sometimes produced by fumegating with mercury, 
the practice has of late been very generally laid a- 
side. 

I think, however, that it may occasionally be em- 
ployed with advantage; and in different instances I 
haye found this to be the case. I will not say that it 

VOL. II, IB 



]38 OF THE REMEDIES USED Ch. IV. 

ought ever to come into general practice, but I am 
clearly of opinion that it should not in all cases be laid 
aside. The fumes of mercury being applied to ven- 
ereal sores will sometimes forward a cure when every 
other preparation has been tried in vain ; and I have 
met with a few cases in which the mercury either went 
off too rapidly by stool when taken into the stomach, 
or where it was not absorbed if applied in the form of 
unction to the surface of the body, and in which it soon 
proved effectual when used in this manner. It is par- 
ticularly useful where venereal sores are seated on 
parts of much importance ; and where, from making a 
rapid progress, there is cause to dread that they may 
prove hazardous. In such circumstances we seldom 
fail in giving a sudden check to the symptoms by fu- 
megating with mercury ; but this is perhaps all that 
we should expect from it. It is obviously of a more 
subtile nature than any other mercurial application. 
It therefore enters the system more readily ; but the 
effects produced by it are not usually permanent. By 
a proper application of the fumes of mercury sores 
may be healed speedily, and the pains induced by 
venereal nodes very completely removed, and yet the 
disease will return in full force if this practice alone 
should be trusted. When therefore it ta judged proper, 
for the reason I have given, to employ mercury in this 
manner, and when the symptom for which it was em- 
ployed is checked, the cure should be completed by 
some other preparation, whose effects, although slow 
are more permanent, as very generally happens both 
from a proper application of mercurial ointment and 
from the internal exhibition of the common mercurial 
pill. In this manner much benefit may be derived 
from a remedy which seems to have been laid aside 
without any sufficient reason, and from our trusting to 
it alone when others ought to be given along with it. 

The fumes of mercury may also be applied with 
safety. They appear to prove hurtful chiefly when 
received in too great quantity into the lungs, but this 
may easily be prevented by burning a small quantity 
at once; and we mav even confine tne steam to the 



SeC. IV. IN LUES VENEREA. 139 

surface of the body, or to any particular part of it 
Such boxes as are employed for confining the steam 
in vapour baths answer the same purpose here. 

We have daily proofs of mercury entering the sys- 
tem by being; absorbed from the stomach and intestines; 
but this mode of exhibiting the remedy is liable to one 
very important difficulty. Every preparation of mer- 
cury that has yet been invented is apt to irritate either 
the stomach or bowels, by which they not only excite 
sickness and purging, but by depriving the patient of 
appetite he soon becomes much emaciated and debili- 
tated. When pushed far indeed the effects of mercu- 
ry given in this manner are in some instances very dis- 
tressful. The stomach becomes so much weakened 
that any food taken into it is eiiher immediately re- 
jected, or remains undigested, and the bowels are so 
entirely deprived of their tone that thej seem to lose 
all power of retension. Even when completely emp- 
tied a degree of tenesmus often takes place, from 
which a great deal of misery is often experienced. 

The preparations of mercury which do least injury 
to the stomach and bowels are those, as I have already 
observed, that are obtained by agitation or triture ; 
but even they prove frequently troublesome, and re- 
quire always a good deal of management. They 
should never be given in large doses; and as soon as 
any degree of irritability is induced by them, either 
in the stomach or intestines, aj opiate should be given 
along with them. Of these preparations, the best and 
most convenient form is the blue pill of the Edinburgh 
dispensatory, of which four grains of the mass, which 
contains one grain of mercury, being given three times 
a-day, will in most instances affect the mouth in a very 
short time. Some constitutions indeed require more> 
but this seldom happens where the mercury has been 
sufficiently triturated. Wherever much more than 
this has been given the mercury either has not been 
properly triturated or we may conclude that much of 
it has passed through the intestines without being ab- 
sorbed, or that the constitution of the patient resists 
this effect of mercury, 



140 OF THE REMEDIES USED Cll. IV, 

Mercurius alkalisatus, and Plenck's solution of mer- 
cury in mucilage of gum arabic, are nearly of the 
same nature with the blue pill, but they are both more 
apt to purge, particularly the latter, notwithstanding 
of all that Plenck the inventor has said to the contrary. 
When properly prepared no more mercury should be 
given in either of these formulae than in the mercurial 
pill ; and as a much greater quantity is commonly di- 
rected, this can only proceed from neither of the pre- 
parations being made with sufficient exactness, and 
from much of the mercury which they contain being- 
left altogether inert by not being duly triturated, 

Many will be surprised at the small doses of these 
articles which I have mentioned here, as more than 
double of this is commonly given. It is not uncom- 
mon to advise six, seven, or eight of the blue pills 
daily ; and twenty grains of mercurius alkalisatus is 
recommended for a dose.^ Now I know from daily 
experience that the blue pill when properly prepared 
cannot be given in this quantity. I seldom give more 
than tw r o pills a day, and very rarely above three ; and 
in each pill, as I have observed, there is exactly one 
grain of mercury. But the mass from which these are 
formed is prepared with much attention : they are tri- 
turated six or seven hours daily for thirty or forty 
days ; and when the mercurius alkalisatus is properly 
prepared it proves equally powerful ; but it is difficult 
to separate the particles of mercury when rubbed with 
a dry powder, that this preparation is now very gen 
erally laid aside. It requires to be rubbed for at least 
one hundred days, in order to bring all the mercurv 
into a state of activity. 

Some are of opinion that mercurius calcinatus is 
equal in its effects to any of these preparations.! The 
dose is a grain or two evening and morning, either in 
the form of a pill or powder. It will certainly cure 
tie disease, and it puts a stop to the symptoms perhaps 
as soon as any other form of mercury ; but I have 

* Vide Mr. Hunter's Treatise oh the Venereal Disease, 
f Vide Appendix, No. 7 



Sec. IT. 1$ LUES VENEREA, 141 

sometimes thought that its influence is not so perma- 
nent ; that is, the symptoms have been more apt to re- 
cur after a sufficient quantity of this medicine was sup- 
posed to be given. But so many facts are requisite to 
ascertain this that I cannot speak decisively about it. 
From all that I know of it, however, it does not ap- 
pear to be equal to the blue mercurial pill. The ease 
with which it is prepared seems to be the only circum- 
stance in which it has a preference ; but this is a point 
of little moment when put in competition with utility. 
A tendency which it has to act upon the stomach and 
bowels may for the most part be checked by the ad- 
dition of a small quantity of opium. 

Hydrargyrus muriatus corrosivus, commonly term- 
ed corrosive sublimate, when it does not affect the 
stomach, proves frequently a very useful medicine. 
It was never generally employed for internal use till 
the celebrated Van Swieten brought it into repute. 
It has since been much used in almost every part of 
Europe ; and being easily disguised, and not so apt to 
salivate as other preparations of mercury, it has form- 
ed the basis of almost all the quack medicines that has 
of late been employed for the cure of this disease. 

The form of using this medicine by Van Swieten 
is, however, the most nauseous of any. He advises 
it to be dissolved in spirits, and one or two spoonfuls, 
containing from a quarter to half a grain of mercury, 
or even more, is commonly given evening and morn- 
ing ; and this is directed to be continued till a cure is 
accomplished.* Few can bear it in this manner; for 
it not only affects the stomach, but in this quantity it 
is apt to excite diarrhoea. Neither can it be with safe- 
ty given in powder, as it is not easily levigated so fine- 
ly as to prevent it from acting mechanically upon the 
stomach. The best form of using it seems to be in a 
watery solution, and this may either be given in a mu- 
cilaginous mixture or mixed with broths, or the solu- 
tion may be made into a mass with crumbs of bread, 
wheat-flour, or flour of liquorice, and divided into 

* Vide Appendix, No. 10 



242 OF THE REMEDIES USED (Jh. IV, 

pills.^ Instead of giving it in larger doses evening 
and morning, it answers better to give the same quan- 
tity divided into four or five doses. A grain of mer- 
cury may in this manner be given daily ; that is, a quar- 
ter of a grain four times a day. Some have advised 
more, but this is the largest dose that I have ever been 
able to continue for more than two or three days to- 
gether. 

Opiates have not the same influence in preventing 
corrosive sublimate from acting upon the stomach and 
bowels which they commonly have with other prepar- 
ations of mercury. I have found nothing so effectual 
for this purpose as decoction of guaicum and mesere- 
on, or plentiful dilution with mucilaginous drinks and 
broths. These may act in the first place by sheathing 
the stomach and bowels directly from the effect of the 
medicine ; and they may also prove useful by promot- 
ing the natural tendency which this form of mercury 
seems to have to pass off' by the skin. 

Mercurius dulcis, or calomel, is given by some in 
large doses for the cure of syphilis, even to the extent 
of ten grains daily .f I have not found, however, that 
this is necessary, and it very commonly proves inju- 
rious both to the stomach and bowels. It answers bet- 
ter in doses of a grain repeated three times a day, by 
which it more readily enters the blood than when giv- 
en in larger quantities, and is less apt to be carried off' 
by stool. 

This form of mercury has long been in general use, 
and there cannot be a greater proof of its safety and 
utility than its being still preferred by many of our 
best practitioners. When as completely deprived as 
possible of its acid, I believe it to be one of our best 
saline preparations of mercury. In this state it com- 
monly operates mildly, and is equally powerful with 
any other form of the medicine in curing the venereal 
disease. 

Mercury in this form is best given in a bolus, in 
piiis, or in powder, for it is scarcely in any deg 

* Vide Appendix, No. ll. 
f Vide No. 9, 



SeC. IV. IN LUES VENEREA. 143 

soluble in water, and it is so heavy that watery flu 
do not suspend it, so that it cannot easily ue given 
a mixture. 

The pulvis mercurius cinereus is another very use- 
ful preparation of mercury.* It also requires to be 
given in a solid form. The dose is two, three, or four 
grains evening and morning. Some have advised more, 
but I have not found that in common practice more 
can with safety be given. 

Hydrargyria vitriolatus flavus, or turpethum mine- 
rale/ is particularly apt, as I have already observed, 
to act upon the stomach ; but even this form of mercu- 
ry may be so given as to cure the venereal disease and 
yet prove sufficiently mild in its operation.f In doses 
of five, six, or seven grains it acts as a violent emetic, 
but it may with safety be given to tne extent of a 
grain, two or three times a day, particularly if each 
dose be conjoined with half a grain of opium. 

Hydrargyrus acetatus, or mercury combined with 
the acid of vinegar, is certainly more mild in its ope- 
ration than any of the other saline calces of mercury; 
nay, it does not derange the stomach and bowels so 
much as triturated mercury is frequently found to do; 
but from all the trials that I have made of it, I do not 
consider it as equally certain in curing the venereal 
disease. The symptoms abate while the patient is un- 
der it ; but if some other preparation of mercury is 
not employed either along with it or continued after- 
wards, they are very apt to appear again soon after it 
is laid aside. 

I have judged it proper to take this particular notice 
of all the preparations of mercury now generally em- 
ployed for internal use ; and from what 1 have said, it 
will be obvious that some of them are for ordinary pur- 
poses preferable to others. In common practice, the 
preparations of mercury obtained by trituie, and par- 
ticularly the blue mercurial pill, will be found to be 
the best. But as cases sometimes occur which do not 
readily yield to any one form of medicine, we are un- 

* Vide Appendix, No. 15. 
f Vide No. 16. 



J 44 OF THE REMEDIES USED Cll. IV. 

der the necessity of having recourse to others; and 
from what we have already had occasion to remark, 
the choice may be readily determined. We shall be- 
sides have farther opportunities of speaking upon this 
point when we come to treat of the cure of the differ- 
ent symptoms of the disease. 

But although we may in a great proportion of cases 
be able to cure the disease by one or other of these 
forms of mercury, and in most instances without any 
injury to the constitution, yet we find that even the 
mildest preparation we can employ, and under what- 
ever caution it may be given, is occasionally apt to af- 
fect both the stomach and bowels in such a manner 
that we are under the necessity either of giving it in 
too small quantities for the purpose of curing the dis- 
ease, or of laying it aside perhaps entirely, in order 
to make trial of the medicine in some other form. 

Our surest method of obviating this effect of mer- 
cury is to apply it to the surface of the body only, a 
practice which ought as much as possible to be adopt- 
ed, and to which the chief objection is, the trouble of 
applying it. The advantages, however, whici attend 
it are so great that every objection of this kind should 
as much as possible be made to give way to it. A pa- 
tient may be so situated that he cannot use the medi- 
cine in this way ; and instances occur occasionally in 
which the mercury is not readily taken up by the ab- 
sorbents on the surface of the body. In both of these 
cases we are under the necessity of giving it inwardly ; 
but scarcely any other good cause can occur for it. 
Nor would either of these be frequent if the advanta- 
ges of the practice were sufficiently explained to our 
patients, and due attention given to the proper appli- 
cation of the mercury. It sometimes indeed happens 
that mercury does not easily enter the system in any 
form, and does not in the usual time affect either the 
salivary or other excretory organs. In such cases, 
where the symptoms of (he disease are urgent, we 
should not be confined to any one method of cure, 
and the medicine should be given in every form in 
which it is likely to prove useful : but it is proper to 



♦Sec. rv. in lues venerea. 145 

remark, that failures of this kind are much more fre- 
quent from the internal exhibition of mercury than 
from the outward application of it, and which is an- 
other important advantage that we derive from using 
it in this manner. Different reasons indeed may be 
mentioned for this being the case ; the readiness with 
which mercury given by the mouth is carried off by 
stool ; the great quantity of food with which it is often 
mixed in the stomach, and by which we may suppose 
that a considerable part of the small quantity that we 
dare ever venture to give in this manner is prevented 
from coming into contact with the absorbents of the 
intestines ; and lastly, the great extent of surface to 
which we can apply it externally. 

By some it is alleged as an objection to this mode of 
using mercury, that we cannot exactly ascertain the 
quantity that enters the system. This, however, holds 
equally strong against every way in which we can give 
it, nor is it a point of any importance. It is not so 
much by the quantity we employ, as by the effects 
which ret lit from it, that we ought to be directed. The 
usual efft zts of mercury upon the mouth, and in the 
cure of the different symptoms of the disease, will, 
with some patients, take place from half the quantity 
of medicine required by others ; but were it an object 
of much more importance than it appears to be, I do 
not see how the quantity of active mercury entering 
the system, in any way we may use it, can be ascer- 
tained. 

It is also mentioned as an objection to the external 
use of mercury, that it is more apt to excite salivation 
than when given by the mouth. This, however, is not 
so much an objection to the practice as to the mode of 
conducting it. Mercury used in this manner enters 
the system for the most part so readily, that those who 
have not been accustomed to prescribe it, are no doubt 
apt to be deceived with it. It proceeds quickly to 
the salivary glands, and is thus more apt to excite sud- 
den salivation than when taken into the stomach ; but 
this proceeds altogether from inattention, and may al- 
ways be prevented by applying the mercury in small 

vol, ir, 19 



146\ OF THE REMEDIES USED Oh. IV. 

quantity at first, and increasing it according to its ef- 
fects. Our being able to affect the system more speed- 
ily by the external application of mercury should be 
considered as another advantage of this mode of ex- 
hibition ; for the symptoms of syphilis in some instan- 
ces advance, so rapidly that it is an object of import- 
ance to check them as quickly as possible. Salivation 
appears to be the effect of a certain quantity of mer- 
cury in the system, in whatever way it is introduced. 
Some of the more acrid preparations pass off indeed 
more readily by other emunctories, but the milder 
forms of the medicine, and which I have endeavoured 
to shew, ought in most instances to be preferred, are 
equally ready to excite salivation. It is true that more 
time is required to throw the quantity into the system 
that is necessary for this purpose by one mode than by 
another, but when this quantity is introduced the ef- 
fect of the mercury upon the glands of the mouth is 
uniformly the same in whatever way it is accomplished. 

Upon the whole, therefore, all the objections that 
have been made to this method of exhibiting mercury 
are trifling when compared with the advantages it pos- 
sesses over every other mode of using it, so that for 
general practice it ought to be preferred. 

1 own indeed that at one period I was of a very dif- 
ferent opinion upon this point ; but this proceeded 
from my not being so well acquainted with the supe- 
rior advantages of using mercury in the form of unc- 
tion as I now am, and which I now therefore very 
generally prefer. 

Mercury will pass into the system in various forms 
from the surface of the body. Lues Venerea has been 
cured by frequent immersions of the feet and legs in a 
solution of corrosive sublimate. The application of a 
mercurial plaister to the surface of the body, if of any 
considerable extent, will also cure the disease ; and we 
are indebted to Mr. Clare of London for a third meth- 
od of throwing mercury into the system from the sur- 
face.* By rubbing calomel into the inside of the 

* Vide an Essay on the Cure of Abscesses by Caustic, &c. also a New 
Method of introducing mercury into the Circulation, by P. Clare, Surgeon. 



BeC. IV. IN LUES VENEREA. 147 

cheeks Mr. Clare found, and his observations have in 
some degree been confirmed by experience, that we 
can not onlv excite salivation bv this means, but cure 
every symptom of syphilis. Nay, the rubbing of a 
few grains of calomel upon the inside of the preputi- 
um or labia pudendi soon affects the system and ex- 
cites the mercurial fcetor in the breath and soreness of 
the gums. But although I have found 1 bis in some in- 
stances to be true, the practice has also in several of 
the trials I made of it failed entirely ; that is, it did 
not cure the symptoms for which it was employed, and 
which were afterwards removed by other preparations 
of mercury. I must own, however, that the experi- 
ence I have yet had of this method of using mercury 
does not entitle me to speak decisively concerning it ; 
but I conclude either that similar failures, or some 
other objections of importance, have occurred to it in 
the practice of others, for we do not now hear that it is 
employed, although Mr. Clare's book has been pub- 
lished upwards of twelve years. 

One obvious cause of this, and of the other modes 
I have mentioned of applying mercury externally fal- 
ling into disuse is, that all of them seem to be much 
inferior to the method of introducing it in the form of 
an ointment, and which was the fir=st, I may observe, 
that was employed for the cure of Lues Venerea. It 
is commonly termed the method of cure by unction, 
or inunction. 

An ointment for this purpose may be made with dif- 
ferent proportions of mercury ; but the best I have 
tried is that in which there are two parts of the unguent 
to one of crude mercury. In the form commonly 
used the ointment and mercury are in equal parts ; but 
the other, while it proves equally powerful, if it be 
applied over a greater surface, has the advantage of 
not being so apt to irritate the skin. 

In order to promote the absorption of the mercury- 
it has been the practice with many to advise the body 
to be immersed in a warm bath, once and again, be- 
fore the course is commenced, and to repeat it once or 
twice a week during the whole continuance of it. Thev 



148 OF THE REMEDIES USED Cfa. IV, 

likewise think that the bathing proves useful by giving 
the mercury a particular determination to the skin, 
and thus preventing it from producing salivation. I 
have not found, however, that a frequent use of the 
warm bath is necessary. It cannot in every situation 
be obtained but with much difficulty, and if not very 
properly conducted it is apt, during a course of mer- 
cury, to expose the patient to suffer from the effects of 
cold. 

Before the commencement of the course, where t lie 
skin is particularly dry, I have sometimes thought it 
right to advise the use of a warm bath, but as in other 
instances of a similar nature the remedy has answered 
equally well where this precaution was not taken, I do 
not conceive that it is of much importance, and I now r 
seldom employ it. 

Where the remedy is chiefly employed for the re- 
moval of a local affection, such as bubo, we endeavour 
to make it pass through the lymphatic vessels of the 
part, and in such cases this determines the place to 
which the ointment should be applied ; but where no 
local symptom of this kind takes place it may be ap- 
plied with equal safety and propriety to any part of 
the body, and the place of application should be 
changed from day to day. By this means we obviate 
the irritation of the skin, which is apt to happen from 
applying it repeatedly to the same place, at the same 
time that we promote the absorption of the mercury 
I may also reomrk, that although, for the reasons I 
have given above, it does not appear to be necessary 
to immerse the whole body in a warm bath during a 
course of mercury, yet that some advantage is occa- 
sionally derived from causing the parts upon which 
the ointment has been rubbed to be well bathed with 
soap and water before repeating it upon the same place, 
It may therefore be proper to advise this to be general- 
ly done. 

In applying the ointment some have imagined that 
we need only Jay it upon the skin, and that it will 
enter the absorbents with equal certainty whether fric- 
tion is used or not, This, however, is bv no means 



SeC. IV. IN LUES VENEREA. 14& 

the case. I have repeatedly put it to the test of ex- 
periment, and it evidently appears that absorption is 
promoted by gentle friction. This indeed is so con- 
sonant to general experience, that some may be sur- 
prised at my taking notice of it, nor would I have 
judged it necessary if the contrary opinion had not of 
late been supported by authority of some weight. 

When the patient is able, the friction should be ap- 
plied with his own hands : Otherwise it must be done 
by an assistant, his hands being covered with a thin 
bladder. For want of this precaution, the assistant is 
apt to be salivated while the patient is deprived of a 
portion of the mercury. According to the nature of the 
case, from a drachm and a half to two drachms of the 
ointment should be rubbed in daily, and it answers bet- 
ter to apply it at two different times than all at once. 
For the purpose of applying properly this quantity of 
ointment, that is from forty-five grains to a drachm, 
twenty or twenty-five minutes of gentle friction is neces- 
sary, the patient while under it being exposed to the 
heat of a moderate fire. 



Fumigation with Cinnabar was introduced at an early date, but 
from the injurious consequences which frequently ensued, it grad- 
ually lost its reputation. In the year 1736, says Mr. Pearson, an 
empiric, of the name of Charbonnier, appeared at Paris, profess- 
ing to use mercurial fumigations, after a new mode, safe and suc- 
cessful. Several of his patients, whom he was permitted to select 
from different hospitals, were undoubtedly cured, yet he often fail 
ed and what was more important, a greater proportion of persons 
died under this mode of treatment, than when mercury was admin- 
istered in the usual manner. After this time, the practice was 
nearly abandoned, until the year 1776, when the Chevalier Lalon- 
ette, a Physician in Paris, published an account of a new method 
of curing the venereal disease by fumigations. His preparations 
were free from the inconvenience of sulphureous vapours during 
their combustion, and he stated that in the space of thirty-five years, 
he had successfully treated more than 4000 cases, that had resisted 
all the ordinary methods of cure. The following account of his 
method we extract from Mr. Abernethy. " It consisted in inclosing 
the patient previously undressed, in a kind of box resembling a 
sedan chair, with an opening at the top to let out the head and an, 
other at the bottom, to which was fitted a small grate, or furnace, 
having in it a heated iron to convert the mercurial remedy into fume, 
The preparation he made use of was a kind of calomel, which bv 



150 OF THE REMEDIES USED Ch. IV. 

repeated sublimation from iron filings, was so far deprived of its 
muriatic acid, as to be in part reduced to running quicksilver; and 
while it possessed considerable volatility, was perfectly irritating. 
Some oi this powder being strewed upon the hot iron placed below, 
was immediately converted into smoke, which surrounded the pa- 
tient's body, and after some time settled on his skin in the form of a 
white and very fine calx of quicksilver : a complete dress, having 
its inside fumigated with the same powder, was then put on. The 
remedy being thus applied to the mouths of the cutaneous absorb 
ents, soon got admission into the circulating fluids and the constitu- 
tion became more speedily affected than by any other process known 
before." (Abernethy's Surgical and Physiological Essays. Part 2. 
London. 1793) 

This method of introducing mercury into the system was adopted 
by Mr. Abernethy in several instances with complete success, and 
from his experience, he draws two conclusions in favour of it, first, 
that it affects the constitution when other means have failed, and 
second, that its effects are produced in a much shorter time, than any 
other mode requires. Mr. Abernethy adds, that the feelings of the 
patient during the operation are not unpleasant, provided the heat 
is properly regulated. Finding M. Lalonette's fumigating powder 
very operose and expensive, Mr. Abernethy employed the follow 
ing, in which the muriatic acid is abstracted by the volatile alkali - 
Two drachms of Aqua Ammonise are added to six ounces of dis- 
iiiled water, and four ounces of Calomel are thrown into this liquor, 
and shaken up with it; the powder is afterwards separated by a fil- 
ter and dried. The powder thus obtained, is of a grey colour and 
contains a good deal of quicksilver in its metalic state, which of 
'•curse is extremely volatile, but become oxydated when raised in - 
to fume, and afterwards condenses into a white and very fine dust 
This method, Mr. Abernethy found extremely useful in healing 
extensive venereal ulcerations, and indeed considers it adequate to 
the cure of any variety of the disease. (Abernethy ut Sufira.) 

Mr. Pearson procured Mr. Lalonette's fumigating machine in 
1786, and instituted a number of experiments to ascertain the com- 
parative advantage of this method and the practice of unction, lie 
found that the gums became more speedily turgid and tender, and 
the local appearances were sooner removed, but to counterbalance 
this, debility and ptyalism was induced in a short time and a rapid 
manner. Mr. Pearson concludes by observing, that where it is ne- 
cessary to check the disease suddenly, where the body is covered 
with venereal ulcers, or where the eruptions are so numerous, as 
not to allow the use of mercurial ointment, the application of the 
vapour of mercury will be advantageous. This method is however 
hardly sufficient to secure the patient from relapse. Applied to 
Venereal Ulcers, Fungi, and Excrescences, Mr. Pearson found 
fumigation very efficacious, but he observes, that an equal quanti- 
ty oi mercury must still be introduced into the circulation, as if the 
local application were not a mercurial one. (Pearson on the effect- 
of various articles in the cure of Lues Venerea, 1st Edit. 1800.) 

If it is judged proper to fumigate venereal sores about the geni 



SeC. IV. IN LUES VENEREA. 151 

tals, it will be most convenient to place a red hot heater at the bot- 
tom of anight stool-pan, and after sprinkling a few grains of Cin- 
nabar on it, seat the patient on the stool. (Cooper's Surgical Dic- 
tionary.) 

The Blue Pills, or Pilula Hydrargyri is a very common prepara- 
tion, and much used in conjunction with mercurial friction. Should 
they purge, opium may be combined with them. This preparation 
is a favourite one with Mr. Pearson. 

The Hydrar gyrus cum Creta, or Mercurius Alkalisatus of Mr. 
Bell, is not at present in much repute. 

The Red Oxyd of Quicksilver was much used by Mr. Hunter, 
and is considered by many as a more certain remedy in curing the 
disease, and preventing secondary symptoms, than any other mode 
of exhibiting mercury. The difficulty and expense attending its 
preparation, has in many instances, prevented its general use. From 
our own observation however, we venture to recommend it as a high- 
ly valuable medicine. 

The Corrosive Sublimate after the testimony of Van Swieten, was 
very generally introduced, and the reports in favor of it, says Mr. 
Pearson, would fill a volume of considerable magnitude. Among 
its advocates may be found the names of De Haen, Pringle, Cleg- 
horn, Russel, Stoll and Lewis. Dr. Locher, of Vienna, who had 
the care of a hospital for venereal patients, states that he has treat- 
ed near 5000 cases with success. Mr. Pearson has not however 
found it equal in the cure of primary symptoms to simple Mercury, 
Calomel or Calcined Mercury, and although useful in secondary 
symptoms, has not observed any permanent benefit from it, new 
symptoms appearing during the use of it, He does not consider it 
safe to confide in this preparation alone for the cure of any truly vene- 
real symptom. (Pearson on the effects of various articles in the 
cure of Lues Venerea, 1st Edit.) 

In exhibiting the corrosive sublimate, we would at all times re- 
commend the giving it in pills ? in preference to the nauseous mode 
of solution. It will be proper to acid a small quantity of opium to 
the prescription given by our author, (Appendix No. 11.) and in this 
form, the bowels are not so liable to be affected as many imagine. 
In combination with the decoction of the woods, it is a highly valu- 
able preparation. (See Francis' Observations on Mercury, in Amer, 
Med. and P. Register, vol. 4. p. 476.) 

Calomel is at present but little given by British Surgeons for the 
cure of Lues Venerea. If it is intended to excite salivation, it 
should always be combined with opium. As an alterative, it will 
be found useful to combine it with antimony, in the form of the 
Plummer's Pills. 

R. Sulphur of Antimony. 

Calomel aa 3 U J- 

Extract of Gentian. 

Castile Soap aa ^i. 
Mix. Make a mass and divide it into ISO Pills. 



152 * OF THE REMEDIKS USED Cil. JV V 

The remaining preparations of mercury for internal use, enume- 
rated by Mr. Bell, are at present in but little repute. 

The Hydrar gyrus Phosfihoratus has within a short time attained 
some celebrity on the continent, as an anti-venereal, particularly in 
inveterate secondary symptoms, such as exostosis, and chronic com- 
plaints of the skin. It is given, in the quantity of 1-4 of a grain a 
day, which may be increased, if the patient can bear it. (Cooper's 
Surgical Dictionary.) 

In the note to the next section, we shall continue our remarks on 
these preparations of mercury, which we have found most useful in 
the cure of this disease. Ed. 

VI. Of the Duration of a Mercurial Course, and the 
Quantity of Mercury to be exhibited. 

In the preceding parts of this section I have enume- 
rated the different preparations of mercury which 
chiefly merit attention, with the doses of each, which 
may with safety be employed. I am now to offer a 
few observations upon the quantity of mercury to be 
given, and the length of time to which a course of this, 
medicine should extend ; questions of the first impor- 
tance in the treatment of the venereal disease. 

As salivation is one of the most obvious effects of 
mercury, practitioners began very early to imagine 
that the morbid matter of Lues Venerea was carried 
off in this manner; and at last it was generally be- 
lieved that a cure could not be obtained if a very 
considerable discharge of saliva did not take place. 
In consequence of this every patient labouring under 
Lues Venerea was made to salivate; and as it was 
thought to be of importance to have this quickly 
accomplished mercury was immediately applied in the 
most effectual manner for this purpose. It was either 
prescribed in large doses, and these frequently repeat- 
ed by the mouth or frictions with strong mercurial 
ointment were applied over the legs and arms, and in 
some instances even over the whole body. 

In this manner the system was very quickly charged 
with as much mercury as it could bear, and for the 
most part a cure of all the symptoms was no doubt ef- 
fected : But the sudden manner in which this great 
quantity of mercury was introduced, and the violent 



gee. IV. IN LUES VENEREA. 353 

evacuations which it excited, together with the low 
regimen with which it was commonly accompanied, 
reduced even the strongest constitutions to a degree of 
debility from which they seldom entirely recovered ; 
so that a great proportion of all delicate people sunk 
under it. 

A course of mercury, conducted in this manner, be- 
came therefore nearly as formidable as the disease for 
which it was prescribed, and no other remedies being 
discovered the same practice was still pursued, till a 
considerable time after the commencement of the pre- 
sent century. About this period some abatement of 
this rigorous course was introduced ; but it was not 
till of late years that any material innovation took 
place in it. 

This ma}' be considered as one advantage among 
others that might be mentioned which we have derived 
from rational theory. Some practitioners suspecting 
that the salivary discharge produced by mercury could 
not probably be the means by which the cure of Lues 
Venerea was accomplished, and some trials which fa- 
voured this supposition being made, they soon came 
to think that all the symptoms of the disease might be 
removed with much less mercury than had commonly 
been employed. If the change of practice, which 
occurred as a consequence of this opinion, had rested 
here, much advantage would have been derived from 
it. But this was not the case. In every attempt to 
introduce an alteration, while we endeavour to avoid 
one extreme we are apt to fall into another. The in- 
conveniencies and distress induced by mercury in the 
way in which it had formerly been given being so great 
that every patient was much afraid of being put un- 
der it, any alteration that was proposed for lessening 
their sufferings was most readily adopted, and practi- 
tioners persuading themselves that it might be done 
with safety, and wishing to adopt the treatment of the 
disease to the feelings of their patients, they unfortu- 
nately allowed this to carry them too great a length. 
So far as the ease, and comfort of a patient is consist- 
ent with his safety he is certainly entitled to it, but 

vol. it. 20 



154 OF THE REMEDIES USED Cll. IV. 

more than this be should not be indulged in. There 
is much cause, however, to think that this has hap- 
pened in the change of practice which has taken place 
in Lues Venerea. Instead of the full salivation that 
patients were formerly put under, and the strict con- 
finement with which this was accompanied, a course, 
commonly termed alterative, was judged sufficient, 
In this, if the mercury is allowed merely to be felt in 
1he breath, or by the slightest soreness of the gums, it 
is never permitted to go farther, and the patient, in a 
great proportion of cases, is allowed during the whole 
time that he is taking it to go abroad. That this will 
prove sufficient in many slight infections, and that it 
will even answer in many cases of a worse nature, if 
the course is carried to a proper length, I know from 
experience is true; but I also know that it ultimately 
fails in a great proportion of cases that are more invet- 
erate and of long duration. Even in these it soon 
gives a check to all the symptoms, and will often make 
them disappear entirely ; but wherever the system is 
deeply injured particularly if the disease has attacked 
the bones, although a cure may in some instances be 
completed by such a course, and in all of them may 
be apparently obtained, yet in many the disease will 
afterwards break out again, and in all even the first re- 
moval of the symptoms will be protracted to a much 
greater length than if more mercury had been given. 

When I first engaged in practice the treatment of 
Lues Venerea upon this plan was by many adopted in 
its fullest extent, and I must own that few went more 
freely into it than I did. The opinion of salivation 
being unnecessary, and that an alterative course was 
sufficient, had not only been taught in the schools of 
medicine, but the practice had been adopted by many 
of our best physicians and surgeons. Beginners there- 
fore went readily into it; but if others from farther 
experience have been led to form the same opinion of 
it which I have done it will soon, except in the slight- 
est cases, be generally laid aside. The result of all 
my experience is, that I am now fully satisfied that to 
render general practice in the venereal disease safe ; 



See. IV. IN LUES VENEREA. 155 - 

that is, to guard as much as possible against a return 
of the disease, a middle course must be observed be- 
tween the severe degrees of salivation which our fore- 
fathers judged necessary, and the opposite extreme in- 
to which the moderns have fallen. 

In cases of a slight nature, that is, in the incipient 
state of mild chancres, what is commonly termed an 
alterative course will be found sufficient. If the 
mouth be rendered gently sore, and kept in this state 
for eight or ten days after the chancres are cured,' no 
more will be necessary. But even in the treatment 
of chancres only, if they have been of long duration, 
or not of the mildest kind, and in every other symp- 
tom of the disease, the mercury should in a gradual 
manner be given so as either to induce a very consid- 
erable degree of soreness in the mouth, and which in 
most instances will be attended with an increased dis- 
charge from the salivary glands, or when from pecu- 
liarity of constitution this cannot be induced, we 
should persist in the use of mercury till the febrile 
symptoms which it usually excites are brought to as 
great a height as the patient can easily bear. It will 
generally indeed be perceived that those symptoms of 
the disease to which I allude cannot be cured but with 
such a quantity of mercury as perhaps in every in- 
stance excites heat, quickness of pulse, anxiety, and 
restlessness, and in proportion as the patient is able to 
bear these in a greater or lesser degree the sooner and 
more effectually will he get free of the disease. 

I have already observed that I give a general prefe- 
rence to the method of cure by unction ; but whatev- 
er preparation of mercury we make use of, it ought, 
in ordinary cases, to be pushed in a gradual manner to 
the extent I have mentioned ; and when as much of it 
is employed as is sufficient for this effect it ought to be 
continued so as to keep the system in an equal degree 
under its influence, not only till all the symptoms of 
the disease are removed, but for some time thereafter. 
This will in different cases happen at different periods 
of a course, and with very different quantities of mer- 
cury. It is therefore obvious 4hat nothing decisive can 



156 OF THE REMEDIES USED CI). IV. 

be mentioned, ether of the length of time to which a mer- 
curial course should extend or of the quantity of the 
medicine that should be given. Our surest, and per- 
haps only guide that should be trusted, is the result of 
experience in similar cases; and as the certainty of 
guarding against a relapse is a point of the first im- 
portance nothing should ever be left in doubt that may 
be required for this purpose. In all primary affec- 
tions, that is, in chancres and buboes only, and where 
no other symptom of the disease has appeared, I have 
found that a course of mercury conducted in the man- 
ner I have mentioned, and continued for a fortnight 
after the symptoms have disappeared, has at all time? 
proved sufficient ; but wherever the skin, throat, or 
bones have been affected, I now always advise the 
remedy to be persisted in for the space of a month af- 
ter the cure is apparently completed. I cannot posi- 
tively say that less than this would not do, but in a 
matter of such moment, where the health and happiness 
not only of the patient but of his progeny are at stake, 
it is better to exceed by giving occasionally somewhat 
more than might be necessary than incur the smallest 
risk of the poison being ever to appear at any future 
period. 

I have said that in ordinary practice the mercury 
should be pushed in a gradual manner to the extent to 
which we mean to carry it; that is, a small quantity 
should be employed at first, and gradually increased 
till the effects expected from it are excited, by which 
we not only avoid the inconveniences which always 
occur from a salivation being suddenly induced but are 
thereby enabled to throw in a much greater quantity, 
and to keep the system more completely under its in- 
fluence during the whole course than we ever can do 
when much mercury is given at once ; and this, I may 
observe, is a point of the first importance in the treat- 
ment of syphilis, for whoever has paid attention to the 
subject must have perceived that our success depends 
in a great measure upon the effects of the medicine 
being fully and regularly kept up during the whole 
duration of the course, and which can seldom be done 



SeC. IV. IN LUES VENEREA. 157 

where it is not given in a gradual manner at first. 
When the fever, salivation, and other symptoms be- 
come severe, and which they are very apt to do when 
the mercury is given in large quantities at first, an 
interruption must necessarily take place, and it is the 
effect of every interruption to protract the continu- 
ance of the course and often to deceive both the prac- 
titioner and patient. My opinion, in short, upon this 
point is, that our certainty of obtaining a speedy and 
permanent cure of any symptom of Lues Venerea is 
not merely in proportion to the quantity of mercury 
we employ, but to the quantity which in an active 
state can be thrown into the system in a given space 
ef time. 

But while with a view to this I have advised that in 
common practice mercury should be given at first in a 
gradual or slow manner, it is proper to remark that 
cases are sometimes met with in which it is necessary 
to adopt a different practice. Wherever the symptoms 
of the disease are particularly urgent, from their 
being deeply seated in parts of much importance* 
and from the progress which they are making being 
rapid, we are justified in deviating from this general 
rule, and in applying the mercury in such a manner 
as will most speedily get it in a very ample quantity 
thrown into the system. In this way a check will 
soon be given to the farther progress of the disease, 
when the medicine, during the rest of the course, may 
be given in the gradual manner which I have just 
pointed out. 

The time to be employed in a course of mercury, 
and the quantity to be given, are circumstances, as 
I have already observed, that cannot with any exact- 
ness be ascertained. They depend in a great measure, 
as we have had occasion to remark, upon the effects 
with which they are attended, but I may observe in 
general, that few cases are so bad as to require the 
medicine, when properly conducted, to be continued 
longer than nine or ten weeks. In recent cases four 
or five weeks are for the most part sufficient ; while 
in some obstinate old affections, where the bones have 



158 OF TriE REMEDIES LSED Cll. IV. 

either been diseased, or the ulcers very foul and ex- 
tensive, I have known it necessary to go on to the 
twelfth or thirteenth week. 

During these periods ointment of the strength I have 
mentioned may be rubbed in from the quantity of three 
ounces to eight or ten. When the blue mercurial pill 
is employed and properly prepared the quantity may 
vary from four or five drachms to two ounces, or even 
to two and a half or three ounces. Whenever these 
quantities are exceeded there is much cause to sup- 
pose that a great proportion of the medicine has not 
entered the system, either from the improper method 
of applying it or some other cause. 

The opinion which I have thus ventured to suggest 
of the effects of mercury depending chiefly upon the 
quantity which in an active state can be thrown into 
the system in a given space of time, will, at first, be 
doubted by many. Being contrary to the practice 
which now generally prevails, few may be inclined to 
follow it, but those who do will have the satisfaction 
to find that by means of it they render their patients 
much more secure than can possibly be done in any 
other manner. By giving as large a quantity of mer- 
cury as the patient can with safety bear, they will find 
that the most inveterate symptoms of the disease may 
be cured in much less time, and with much more cer- 
tainty than they usually are by an alterative course, 
which, however well it may be adapted for the cure of 
the slighter symptoms of syphilis, is by no means suf- 
ficient for the removal of the more advanced stages of 
1he disease. 

Many practitioners think that the same quantity of 
mercury must prove equally useful in whatever time 
it may be given, provided the mouth be kept mode- 
rately sore during the whole period. This, however, 
is not the case. I have met with various instances of 
venereal sores, as well as other symptoms, which had 
either obstinately resisted a very long continued course 
of this kind, or which had recurred from time to time 
after a cure had been supposed to be obtained, and 
ivbich at last were entireJv removed by a much less 



Sec. IT. IN LUES VENEREA. J 59 

quantity of the medicine being given in a shorter pe- 
riod. What I wish to inculcate is, that the more in- 
veterate symptoms of the disease will seldom yield to 
an alterative course of mercury, however long it may 
be protracted, while the same quantity of the medi- 
cine will seldom fail, when given so as to keep the sys- 
tem for a shorter period more completely under its 
influence. I have now the history of more than fifty 
cases in which this actually happened; where venere- 
al sores, from resisting mercury under an alterative 
course, were judged to be incurable, and where com- 
plete cures were afterwards obtained merely by carry- 
ing the use of mercury to a greater length than had 
previously been done. 



We cannot do better than add the observations of Dr. Francis on 
this subject, as they contain a summary of our own practice, and 
the reasons on which it is founded. 

" If the view which has been taken of the nature and seat of the 
venereal disease be well founded, and the circumstances which mod- 
ify its character and method of treatment be correctly stated, much 
also depends upon a judicious choice of the different mercurial pre- 
parations. Those combinations of mercury must possess a decided 
advantage which are least calculated to excite the salivary discharge, 
and whose operation is general throughout the system. Of the va- 
rious preparations of this mineral, now in most general use, the 
oxygenated muriate of mercury, or, as it is commonly called, the 
corrosive sublimate, (the oxynnirias hydrargyria l. p. jnurias hy- 
drargyria e. p. murias kydrargyri corrosivu?n, d. p.) is particularly 
recommended for this purpose. This form of mercury, like every 
other, has had many opponents and adherents. It is thought by- 
some to have been first employed as an anti-venereal by Basil Valen- 
tine ;* but, upon the authority of the celebrated Van Swieten, it 
came into general use only in 1754, and the favourable reports of 
its efficacy " would fill," says Mr. Pearson, " a volume of consid- 
erable magnitude." In the number of its most decided advocates 
may be found the distinguished names of Locher, De Haen, Pringle, 
Cleghorn, Gorden, Russell, Stoll, Lewis, Dease, and Seile. 

Among the principal advantages which the corrosive sublimate 
possesses over that of every other preparation of mercury are, that, 
judiciously administered, it is particularly mild and safe'in its ope- 
ration, will admit of a more extensive use in all the various forms 
of lues venerea, and subject the patient to fewer inconveniences : 
that it readily enters into the general circulation, becomes miscible 
with the several fluids of the body, the soonest arrests the progress 



Peai 



arson on the Effects of Various Articles, &c. p. 100, 



160 OF THE REMEDIES USED Ch* IV. 

of the complaint, and eliminates the morbid matter through those 
emunctories best calculated for that purpose : that it supersedes the 
necessity of salivation, by its action on all the secretions, and by 
promoting especially the cuticular discharges, and the evacuations 
from the kidneys : that it is the only preparation to be depended on 
in those peculiar habits of body so susceptible to become salivated 
by every other form of mercury now in use : that in its ultimate ef- 
fects upon the constitution, it is attended with comparatively no in- 
jury. These facts are indeed truly important, and many of them 
are granted by those who altogether reject the use of this prepara- 
tion. 

It is not a little unfortunate for the advocates of other combina- 
tions of mercury, that the objections which have been brought 
against the corrosive sublimate are so dissimilar. It has been as- 
signed as a reason against the preparation itself, that it has failed o'. 
its salutary effects by being given in too small doses. By some its 
anti-venereal properties are said to be lost on account of its too 
readily exciting the cuticular discharge ; by others it is owing to its 
defective action on the secretions of the skin and mouth. By some 
it is admitted to be beneficial in the primary stage of the disease, 
and by others it is contended that it is calculated to remove only se- 
condary symptoms. It is also declared that it is violent and uncer- 
tain in its operation, and that it does not render the cure permanent.* 
Some of these objections are, indeed, weighty, and, were they well 
founded, would fully justify the abandonment of this peculiar com- 
bination of mercury ; but if the least reliance is to be placed upon 
the experience and observation of those who have employed the 
corrosive sublimate with the most disinterested and honourable 
views, and solely to determine upon its anti-venereal powers, evi- 
dence sufficient to prove the fallacy of these objections, and derived 
from indubitable sources, might be adduced. The testimony of 
Dr. Locher, of the Vienna hospital, is so full and explicit, that it 
were an omission not to insert it. Having witnessed the " horrid 
calamities" arising from salivation and other abuses which existed 
in that institution in the management of venereal patients, upon the 
recommendation of Van Swieten, he made trial of the corrosive 
sublimate. From the year 1754 to 1762, he cured by it no less than 
four thousand eight hundred and eighty persons, without inducing 
salivation ; and testifies, that " no persons died, or experienced the 
least painful and dangerous symptoms, in consequence of this rem- 
edy."! In the cases in which the same preparation was recommend- 
ed by Pringle,! the cures that were effected were permanent, and 
from the repeated experience of many other distinguished practi- 
tioners, the - same result ensued. Muita nobis exempla visa sint 
luis venerese, murcurio sublimato corrosivo perfecte sanat2e.§ 

* Hunter, Howard, Pearson, Mathias, and others. 

j Locher s Observat. Pract. as quoted by Van Swieten, Commentaries, vol. 
17. p. 294. 

* Gorden, Lond. Med. Obs. and Inq. vol. 1. p. 365. vol. 2. p. 73. 

§ Ratio Medendi, pars secunda, p. 229. See also Medica Clinica, bv Chris- 
tian Gottlieb Selle. Berlin, 1802. 



Sec. IV. IN LUES VENEREA. lit 

To enter into a consideration of the treatment of the various 
symptoms which characterize lues venerea in its simple and in its 
•more confirmed state, is not deemed necessary, nor will it here be 
attempted. Fully convinced, as the writer is, of the decided advan- 
tages which the corrosive sublimate, as an anti-venereal remedy, 
possesses, in most cases, over other mercurial preparations, he 
cannot forbear adding a few further observations for the purpose o£ 
recommending- to more general use this combination of mercury. 

A very forcible reason why a preference ought to be given to the 
corrosive sublimate as an anti-venereal remedy, is the mildness of 
its operation when compared with most other mercurial prepara- 
tions. In the mind of the judicious practitioner, there need exist 
no apprehensions of the severity of its action ; few articles of the 
materia medica can be more readily accommodated to the peculiar 
condition of the patient and the nature and stage of the disease. 
The evidence of its mildness may be adduced from the salutary ef- 
fects which it produces in the constitution of delicate children, and 
even of infants. In not a single instance, within the recollection of 
Dr. Hcsack, has it ever been followed by pernicious consequences, 
though long employed by him in many cases in which the patient 
laboured under some hereditary taint, obstinate cutaneous eruption, 
or ether symptoms indicating an alterative course of remedies. The 
destructive effects which have been mentioned as attending its ad- 
ministration, such as excessive pain and irritation of the stomach 
and bowels, headach, fever, &cc. may, in certain cases, arise from 
some peculiarity of constitution obnoxious to mercurial remedies, 
but are doubtless, in general, to be attributed either to the impro- 
per preparation of the corrosive sublimate, or to its having been 
given in undue quantity. It has been asserted that this mercurial 
salt is particularly injurious to those labouring under pulmonary af- 
fections. That this objection is ideal, or rather that, of all mercu- 
rial preparations, it applies with least force against the corrosive 
sublimate, must be evident upon considering the general operation 
of this form of mercury. Every combination of this mineral may 
prove more or less injurious in the forming stage of consumption, 
on account of the active inflammation which is then present, and 
the additional irritation attendant upon mercurial action. For it 
may be laid down as a general principle, that mercury is in itself in* 
jurious when administered to any considerable extent during the 
existence of inflammation and febrile excitement, and before the 
employment of blood letting or other evacuants. 

From the mild operation of the corrosive sublimate, properly 
prepared, may be inferred the utility of its employment in persons 
of delicate habit, and in those cases especially where the constitu^ 
tion is materially impaired. In cases of this kind its exhibition is 
followed with the best effects. That the tonic powers of the system 
may, however, in certain instances, be so far weakened as to render 
the employment of every form of mercury not only inefficacious in 
the removal of syphilitic complaints, but productive of the most 
distressing symptoms, and, consequently, that the use of the oxy- 
genated muriate "will at times be the cause of much inconvenience 

VOL.11. 2] 



162 OP THE REMEDIES USE© Ch. IV. 

and real suffering, there is left no room to doubt. In irregular ca- 
ses of this nature, the remedy necessarily fails of producing its or- 
dinary beneficial effects ; and as it becomes an additional source of 
irritation, it greatly increases the debility which already prevails. 
These effects, as has just been remarked, do not result from the 
exclusive employment of any particular form of mercury ; they 
seem to arise less frequently from the corrosive sublimate, but are 
common to all mercurial preparations. For if the constitution has 
not the power to support the action of mercury, vain is the attempt 
to eliminate from the system the virus of lues venerea. Hence, in 
the treatment of certain diseases of hot climates, especially in un- 
healthy situations, it is not an uncommon practice to administer the 
bark daily during the whole course, for the purpose of enabling the 
constitution to bear a sufficient quantity of mercury to subdue the 
complaint.* Upon the same principle that learned physician and 
distinguished writer, Dr. Chisholm, maintains, that in the manage- 
ment of disease a reduction of plethora at the commencement, and 
the augmentation of the vis vitss in the advancement, are to be par- 
ticularly attended to, in order to ensure the successful administra- 
tion of mercury .f Dr. Ferriar has observed instances in which the 
venereal disease itself assumed a peculiar character owing to debili- 
ty ; where the debility so far prevailed that the constitution had not 
power to form a genuine syphilis. When this happens, mercury 
will not effect a cure. " Under these circumstances," adds Dr. 
Ferriar, " I have advised with success a course of tonics without 
mercury, to raise up the constitution to a higher level. Mercury 
may then be expected to cure.*^ 

It was deemed proper to make these few remarks on the condi- 
tion of the system necessary to ensure the successful operation of 
mercury, not only from the circumstance of its being too geneially 
overlooked, but because it strengthens the belief that the pernicious 
effects which have been so hastily attributed to the corrosive subli- 
mate, might have been more satisfactorily accounted for by advert- 
ing rather to the debilitated state of the constitution than to the 
acrid nature of the preparation itself. 

Difficult as it is to establish any diagnostic signs by which the de- 
predations of Venus and of Mercury on the human constitution may 
be accurately distinguished, enough is known concerning the nature 
of mercurial affections to lead to the abandonment of that indiscrim- 
inate recourse to the external application of this mineral, which 
has now become so general. Mr. John Pearson states that the 
mercurial oezena, or erythema, as it is also called, may arise after 
the employment by friction of a single drachm of mercurial cint« 
ment, and after the internal use of a dose of calomel : and were it 
necessary to say any thing in corroboration of this fact, the writer 
might detail the particulars of a case of vesicular eruption tnat 
lately came under his notice, which occurred in an adult patient to 
whom had been administered eight grains of calomel. The vesicles 

* Vide Clark on the Diseases of Long Voyages. 

f Essay on the Malignant Pestilential Fever, yoI. X-. 

f Med, Hist, and Reflect, vol. 3. p. m 



Sec. IV. IN LUES VENEREA. 163 

first appeared, and were confined, chiefly about the anterior and su- 
perior part of the chest and on the chin ; they were of the size of an 
ordinary split pea, of a pale or rather light gray colour, unaccom- 
panied with inflammation or fever, and strongly resembled the erup- 
tion described by Dr. Willan, in his fourth ordei of Cutaneous Dis- 
eases.* The serous fluid they contained was discharged on the se- 
cond or third day, and the excoriated surface readily healed. But 
notwithstanding that the internal as well as external use of mercu- 
ry, even in small quantity, will, in certain habits, give origin to 
the mercurial erythema, yet a careful examination of what has been 
written on the subject seems to warrant the conclusion that this form 
of disease arises, in a great majority of instances, from mercury 
externally applied. If this opinion be well founded, it presents 
strong additional arguments in favour of the internal use of the cor- 
rosive sublimate as an anti-venereal remedy. 

That the corrosive sublimate, of all mercurial preparations, soon- 
est affects the system and arrests the action of the venereal virus> 
is a truth grounded upon the concurring experience of the most 
distinguished practitioners. 

It is but proper to state, that the preparation of mercury now re- 
commended, has been employed for the last twenty years in the pri- 
vate practice of Doctor Hosack, and during his attendance at the 
New-York State Prison, New-York Hospital, and the Alms-house 
of this city, as physician of those institutions. It has invariably 
been found to be the remedy best calculated for the removal of lues 
venerea, both in its primary and secondary stages; and not a single 
case is recollected in which the cure has not been permanent. Those 
injurious effects upon the stomach and bowels, which are so much 
apprehended, were avoided by a cautious employment of the medi- 
cine, and by a due consideration of the peculiarities in the constitu- 
tion and state of the patient. From this form of mercury, saliva- 
tion scarcely ever was induced ; and while under its influence, the 
employment of the decoct, guaiac. et sarsaparil. was found to be an 
excellent auxiliary in recent cases ; and in the secondary stage of 
the disease, where the patient had been neglected, or when impro- 
prieties in the cure had been committed, it was almost indispensable, 

Though satisfied that the oxy muriate of mercury possessed full 
claims to the title of a powerful anti-venereal remedy, from a peru- 
sal of the testimony published in its favour, and from a personal 
knowledge of the result of several cases in which it had been em- 
ployed ; with the view of more fully determining so important a 
matter, and to ascertain, as far as practicable, whether the objec- 
tions which have been stated against it, particularly those of the 
distinguished Mr. John Pearson, were founded in reality, at the sug- 
gestion of the writer, the use of the corrosive muriate of mercury 
was adopted in the spring of the year 1811, in the New-York Hos- 
pital, by Dr. John C. Cheesman, the tnen house surgeon. From 
the extensive charity which this excellent institution afforded, ther« 

* Vide Cutsm. Diseases ; order Bullje, IIL Genus, sp, i ; . 



164 OF THE REMEDIES USED Cl). IV. 

was abundant opportunity of seeing almost every form of this dis- 
ease, from the more mild to the most aggravated ; cases of recent 
infection and those of long standing. After a careful eywarnination 
of the histories of a great variety of cases, a selection was made of 
several of those patients who were affected with the primary, and 
of others labouring under the secondary stages of this disease. The 
corrosive sublimate was given in some instances in the form of the 
spirituous solution, and in other instances made into pilis; the de- 
coction of guaiacum and sarsaparilla was employed as an auxiliary, 
and occasional recourse was had to the application of the lunar caus- 
tic; but the external use of every preparation of mercury was omit- 
ted. In no one instance were unpleasant effects produced by the 
action of this mercurial salt; and, contrary to the opinion enter- 
tained by Mr. Pearson, of the efficacy of this remedy, the result 
of these several cases was attended with complete success. 

To multiply further arguments, or offer additional proofs in fa- 
vour of the oxygenated muriate of mercury does not seem neces- 
sary. It may be confidently pronounced a safe, convenient, and ef- 
ficacious remedy in lues venerea. How far a too ready acquies- 
cence in the force of authority may be assigned as the cause of that 
want of confidence in the virtues of the corrosive sublimate, and of 
that apprehension of its pernicious qualities which at present pre- 
vail among many practitioners, it is impossible to ascertain. It is 
evident that the opinions of Mr. Pearson are those chiefly which 
have been adopted and reiterated by every subsequent writer who 
has opposed the use of this mercurial combination. But the suc- 
cess attendant upon the administration of the oxymuriate of mercu- 
ry furnishes the most satisfactory answer that can be given to those 
who have denied its efficacy. Upon the successful result of the ca- 
ses of lues venerea which existed in the New-York Hospital in 1811, 
the corrosive sublimate again became the principal anti-vcncreal 
remedy in that extensive establishment. This form of mercury* 
since that period, has also been in general use in the New- York 
Alms-house, in the treatment of syphilis in its different stages ; and 
in most instances it is now employed for the same purpose by the 
physicians of the City Dispensary. The observation and experi- 
ence of the writer during the last three years, in a number of un- 
equivocal cases of lues venerea, have tended to corroborate the fa- 
vourable opinion he formerly expressed,* and induce him to recom- 
mend with increased confidence a more extended application of this 
preparation of mercury. 

Various are the forms in which the corrosive sublimate has been 
used in the different stages of lues venerea, and in other disorders 
indicating an alterative course of remedies. Its external applica- 
tion in the form of ointment, has been recommended by some ; but 

* Vide An Inaugural Dissertation on Mercury: embracing its Medical His- 
tory, Curative Action, and Abuse in Certain Diseases. Neno-Yorifc 1811. The. 
present communication, and a former one on the same subject, which appear- 
ed in the Register for April, 1813, may be considered a constituting the col- 
legiate exercise just mentioned, though now m some parts enlarged and per- 
haps, somewhat improved. 



Sec. IV. IN LUES VENEREA. lOo 

against this practice many forcible objections might ue brought. 
Tin- internal use of the spirituous solution of Turner, in which the 
proportion of ardent spirits to the mercurial salt was remarkably 
small, has justly been accused as the source of much mischief. 
The formula of Van Swieten deserves a decided preference ; for the 
muriated quicksilver dissolved in spirits and exhibited in doses lim- 
ited to the quantity of one eighth cf a grain, two, or, at most, three 
times in twenty-four hours, seldom produces the least nausea, or 
any derangement of the stomach or bowels. 

The corrosive sublimate, dissolved in common brandy, in the 
proportion of two grains of the salt to one ounce of the liquid, is a 
valuable and convenient preparation for delicate children. It may 
be given with the greatest safety, in a little sweetened water, to the 
amount of three or four drops to a child of one year, and repeated 
three times a day ; and to a child of two or three years old six or 
eight drops three times a day. After its employment two or three 
days the dose may be increased to ten or twelve drops. 

A solution of the oxymuriate of mercury in common distilled 
water, with the addition of a little muriated ammonia, (sal ammo 
mac) is also a judicious and safe pharmaceutical combination. 

But the best form of administering the corrosive, sublimate is that 
in which this mercurial salt, united by solution with the muriate of 
ammonia, is made into amass with the crumb of wheat bread, and 
then divided into pills. 

R. Oxymuriat. Hydrarg 1 . 

Muriat. Ammon. aa gr. xv. 

Aq. distillat. vel. font. Xiss. Solutioni addatiu 

Funis medul. sic. q. s. 

Ut fiat massa, in pil. cxx. dividends. 

Every pill in this prescription contains, if the materials be uni- 
formly combined, the eighth of a grain of the corrosive sublimate;. 
The dose can therefore easily be regulated with the greatest accu- 
racy. Of these pills one is to be taken every night and mbrni 
though, in some aggravated cases, another pill may be taken at the 
middle ot" the day with additional advantage. In this manner a quar- 
ter of a grain of this preparation of mercury will, in ordinary cases, 
be taken in twenty-four hours ; and in the more severe form of lues 
venerea the additional eighth of a grain. Instances may occur in 
which it may be advisable to administer half a grain daily. Mr. 
Beil has given a grain of the corrosive sublimate divided in four or 
five doses, but has not been able to continue this quantity ior more 
than two or three days together. 

The corrosive sublimate to the amount of one quarter of a grain 
a day, and, in some cases, an additional eighth of a grain, in pills, 
may be continued for a long time without producing the least incon- 
venience in the stomach and bowels, and with greater certainty and 
more beneficial effect than the same quantity of this salt in the form 
of tne spirituous solution. The use of the corrosive sublimate 
ought to be continued two or three weeks after the disappearance of 
the disease, in order more effectually to accomplish a radical cure.- 



166 OF THE REMEDIES USED Gh. IV, 

It has already been observed, that the oxygenated muriate of mer- 
cury operates more readily on the constitution than any other form 
of this mineral, and that even in very small quantity it soonest ar- 
rests the progress of venereal symptoms, and, by its general ac- 
tion, eliminates the poison of the disease. It deserves to be stated 
that during the use of this preparation, all those precautionary 
measures with regard to diet and regimen, which are generally re- 
commended by writers, need not be regarded with the same scru- 
pulous attention, while in the use of the corrosive sublimate, as 
during the employment of other mercurial medicines. For as the 
corrosive sublimate rarely affects, to any considerable degree, the 
salivary glands, those subjected to its use are not rendered so sus- 
ceptible to the influence of cold, and the physician is seldom under 
the necessity of devising means for the purpose of obviating the 
pernicious consequences of salivation. Instances of peculiarity of 
constitution may occur which require much management and dis- 
cretion in the use of this remedy. Mr. Bell has observed, that opi- 
ates have not the same influence in preventing an undue action of 
the oxymuriate of mercury upon the stomach and intestinal canal 
which they commonly have with other mercurial preparations.* 
The limited experience of the writer has not in any case corrobora- 
ted this opinion: on the contrary, he has found an occasional re- 
course to small quantities of opium highly serviceable. 

As some one or more articles of the vegetable kingdom are in 
general employed in those cases in which the corrosive sublimate is 
administered, it perhaps would not be irrelevant to examine how far 
they are entitled to particular confidence. It may be proper to re- 
mark, that of the many substances which have been employed as 
auxiliary remedies, or are now in use, the lignum guaiaci and the 
radix sarsafiarilltz unquestionably claim the first notice. They are 
acknowledged to be useful during the administration of the oxymu- 
riate of mercury, in cases of recent affection ; and in the secondary 
symptoms ot the disease, for the removal of the evils which have 
taken place from the injudicious employment of mercury. Sec. their 
salutary operation has been uniformly evinced 

The compound decoction of guaiacum and sarsaparilla may read- 
ily be prepared in the following manner : 

R. Rasur. lig-ni guaiac. 

Rad. sarsapar. fissse aa. 5i. 
Coq. in aq. font, lbiij. ad. lbij. 

Of this decoction the above quantity, taken warm, ought to be 
drunk within the twenty -four hours. Of its effects as a powerful 
alterative for the removal of some of the most painful symptoms of 
lues venerea and obstinate cutaneous affections, indubitable eudence 
exists in the pages of the old and in those of the most eminent mod- 
ern authors.! During a period of more than foit -five years its vir- 
tues for these purposes have been tested in the practice of that 

* Treatise on Gonor. and Lues Ven. vol. 2. p. 248. 

t Vide Aphrodisiacus, Ed. Bogxhaavii, Also., Hunter, Bell., &c< 



SeC. IV. IN LUES VENEREA. 167 

learned and distinguished physician, Dr. Samuel Bard, and for more 
than twenty years in the practice of Dr. David Hosack. Its saluta- 
ry properties appear to be owing chiefly to the general excitement 
which it produces and to its action as a diaphoretic. When had re- 
course to, while in the use of mercury, particularly in the treat- 
ment of those cases where the disease is of long continuance, it 
proves eminently useful by promoting the natural tendency which 
the corrosive sublimate possesses to increase the cuticular dis- 
charge. 

The compound decoction of the guaiacum may be taken with 
success for the removal of many of the morbid effects produced by 
the improper employment of the different preparations of mercury, 
and for restoring the constitution to its wonted vigour. The advan- 
tages arising from the use of the Rob Anti-syfihilitiquei* for which 
so enormous a consideration is demanded, may with confidence be 
attributed principally to the sarsaparilia which enters into its compo- 
sition. 

As the local effects which arise from the venereal virus depend 
upon constitutional irritation, or the action of lues venerea upon the 
constitution, these effects in most cases are to be permanently re- 
moved by those remedies only which operate through the medium 
of the whole system. But the consideration of the local applica- 
tions best calculated as efficient auxiliaries for the removal of these 
consequences is at present purposely omitted/' 

* Vide M'Neven's Account of the Rob of Laffacteur, in New- York Med. and 
Phil, Journal, vol. 3. p. 23. 



VII. Of the Regimen to he observed during a Course of 

Mercury. 

It was formerly the practice and still is in some parts 
of Europe, to put every patient while taking mercury 
upon a low diet, and previous to the commencement 
of the course blood-letting and purgatives were pre- 
scribed. 

When it is necessary in a full habit of body to throw 
in any considerable quantity of mercury very quick- 
ly, and especially when it is known that the patient 
has been liable to inflammatory complaints, some pre- 
vious evacuation is proper, and the patient during the 
first part of the course, should be kept upon a low al- 
lowance. But in general there is no cause for this, and 
the cure proceeds with least difficulty when the patient 
is kept upon his usual diet. It is the effect indeed of 
mercury to produce weakness in such a degree, that if 



i 60 OF THE REMEDIES USED Cfa. IV. 

not counteracted by nourishing diet, it is apt to injure 
the constitution materially. Of this I have met with 
so many instances that unless where some strong ob- 
jection occurs to it, I always desire patients under 
mercury to live as well as a person in health ought to 
do. A full allowance of animal food would in most 
instances be improper, but I have never observed any 
harm occur from a plentiful use of any other article 
that did not disagree with the stomach and bowels. 
When mercury is taken by the mouth acid vegetables 
are apt to do harm ; but there is no cause for avoiding 
them when the cure is conducted by unction. 

Patients under mercury are commonly desired to 
avoid wine and even malt liquor. A great quantity 
of either ought never to be given ; but in moderate 
quantities they may be used with safety. .Different 
opinions have also been entertained respecting the 
propriety of patients going abroad while under mer- 
cury. So far as my observation enables me to decide, 
I think there should be but one opinion upon the sub- 
ject. We are often obliged to allow venereal patients 
when usin£ mercurv to go abroad, and to manage 
their ordinary business, but I have never done so but 
with regret. Exposure to the irregularities of the ex- 
ternal atmosphere always does harm in a course of 
mercury. 

It is apt to produce distress at stomach, pains in the 
bowels, and purging. This necessarily impedes the 
operation of the medicine, by which the cure is not 
only protracted but rendered more uncertain. I am 
clearly of opinion therefore, that this kind of expo- 
sure should at all times be avoided. At the same time 
I do not think it necessary that patients under mercury 
should be kept in a great degree of heat. On the con- 
trary, much advantage is derived from their living in a 
large well aired apartment, and in a degree of heat 
that is most agreeable to their own feelings. Nay, e\- 
?ej)t in the cold weather of winter and spring, there is 
no necessity for confinement to one apartment; and 
any unusual quantity of cloathing, whether in bed or 
: ring the day, is altogether unnecessary* In short, 



Se€. IV. IN LUES VENEREA. l6§ 

much exposure appears obviously to prove hurtful, 
while no advantage is derived from the patient being- 
kept in an unusual degree of heat. 

I think it proper, however, to observe with respect 
to cloatbing, that linen should never be worn next the 
skin during the use of mercury ; whether the patient 
sweats much or not it keeps the surface of his body 
colder than it ought to be ; and if he is liable to plen- 
tiful perspiration he is even apt to be hurt by it. Flan- 
nel should be wore during the cold of winter and spring, 
and cotton when the weather is more temperate* 



We hare not found it necessary, except in very peculiar cases, 
or from the great inclemency of the weather, under our mode of 
treatment, to confine the patient to his apartment ; nor have we at 
any time seen any ill effects from this license, Ed. 

VIIL Of Profuse Salivation and some other Effects of 

Mercury. 

We have already had occasion to see that in the cure 
of Lues Venerea there is no advantage to be derived 
from any increase that may be made to any of the 
secretions. But we have also seen that the advanced 
•stages of the disease cannot be with certainty cured 
without such a quantity of mercury being thrown into 
the system as very commonly excites an increased dis- 
charge of all the secretions, and particularly of the 
saliva. When this continues moderate no harm ensues 
from it, but occasionally they come to such a height 
as to produce much inconveniency and distress. In- 
deed the readiness with which mercury in some cases 
runs to the mouth is such that it is with difficulty a suf- 
fix ient quantity for curing the disease can be given * 
and it produces, I may observe, one of the most dis- 
tressful circumstances that we rneet with in practice. 

The most certain method of preventing severe sal- 
ivation k the gradual exhibition of mercury in the 
manner we have already pointed out. Occasionally 
we succeed in preventing it by guarding against exter- 
nal cold, by confinement to the house and the use of 

VOL. IK 22 



J 70 OF THE REMEDIES USED Ch. IV. 

warm cloathing of flannel or cotton. But while in this 
manner we support a gentle and equal flow of the 
matter of perspiration, severe sweating is to be avoid- 
ed, which always proves hurtful, and even sometimes, 
as I have thought, more so than profuse salivation. 
But in some cases, even with all the attention that can 
be given, the mouth becomes quickly sore, and a grad- 
ual discharge of saliva takes place much sooner than 
is expected. 

Purgatives are the remedies most frequently em- 
ployed for removing salivation: I have not found, 
h >wever, that they prove useful, and when persisted in 
they never fail to do harm, for they weaken the pa- 
t ent, while they seldom have any effect in lessening 
the salivary discharge. 

Blisters have also been advised. The sense of suf- 
focation, which the swelling of the salivary glands 
sometimes gives, .would appear to indicate the use of 
blisters. We do not perceive, however, that they 
have much influence upon the discharge, while by the 
irritation which they excite they very commonly do 
harm. 

As sulphur when combined with mercury renders it 
so inert that it scarcely acts upon the human body, 
many have imagined that it ought to have some influ- 
ence in lessening or removing the ordinary effects of 
mercury upon the system. We do not find in prac- 
tice, however, that these views which theory suggest- 
ed are in any degree realized. It has often been em- 
ployed for" lessening the violence of salivation, but 
few instances have occurred of any advantage being 
derived from it. 

To me i< appears that this effect of mercury is en- 
tirely local, and to be cured therefore with most cer- 
tainty by local remedies. It is obviously the conse- 
quence of irritation produced by mercury upon the 
salivary glands: The dread, therefore, which some 
have entertained of applying local remedies seems to 
have no good foundation; and accordingly I have 
found that they may be employed with freedom. As 
a wash for this purpose lime-water proves useful, bul 



SeC. FV. IN LUES VENEREA. 171 

it requires to be diluted. A strong infusion of red- 
rose leaves, of galls, oak-bark, and other astringents 3 
prove also serviceable ; but the most effectual appli- 
cation I have ever employed is a strong solution of bo- 
rax.* A little of it being kept in the mouth from 
time to time proves exceedingly pleasant and sooth- 
ing, and at last has often an obvious effect upon the 
quantity of the discharge. It may prove in some de- 
gree useful as an astringent, but it seems to act chiefly 
as a sedative by lessening the irritable state of the sa- 
livary glands. 

It is evidently in this manner that opium proves use- 
ful in removing salivation ; for although some advan- 
tage is derived from applying it directly to the parts 
affected in the form of a gargle it proves always much 
more useful when given internally. A dose of lauda- 
anum, sufficient to allay the irritation and pain which 
always accompany a profuse salivation, and to pro* 
cure sleep during the night, not only gives temporary 
relief but is the most powerful remedy we can employ 
for removing the discharge. When the uneasiness 
is severe the opiate should also be repeated in the 
morning. 

Where salivation comes suddenly to a greater height 
than the quantity of mercury we have employed should 
give us cause to expect we are apt to be at a loss, and 
afraid of giving more lest distressful consequences 
ensue from it. In such circumstances, however, I have 
often found that although the usual quantity of mer- 
cury Was continued daily, the salivation was not in- 
creased, and that in this manner it might be persisted in 
till the cure was completed. This will not indeed be 
always the case ; but it succeeds so frequently, that in 
every instance a trial should be made of it, for a cure 
may thus be effected in a few weeks which otherwise 
might be protracted for several months. 

It has also been remarked, if salivation excited in 
this manner be allowed to subside entirely, that the 
same, or even a greater quantity of mercury, may 

* Yide Appendix No, 20. 



112 OF THE REMEDIES USED Ch. If. 

afterwards be exhibited without any risk of the dis- 
charge coming again to a similar height. Of this I 
have met with several instances, so that the prac lice 
may always be adopted when it is found that a prop- 
er quantity of the medicine cannot be continued w ith 
safety from the first. 

One of the most distressful occurrences which we 
meet with in this disease proceeds from a peculiarity 
inherent in some constitutions, by which even the 
smallest quantity of mercury that we employ is apt to 
rush with violence to the mouth. This is particularly 
apt to happen where the patient at the same time la- 
bours under the sea scurvy. In this case our only 
remedy is the removal of the scorbutic diathesis b\ a 
plentiful use of acid vegetables and other antiscorbu- 
tics} but w ere it does not proceed from this cause all 
that we can do is to give those preparations of mercu- 
ry that are least apt to affect the mouth, and to pre- 
scribe them in the smallest doses. In this view corro- 
sive sublimate in small quantities is particularly indi- 
cated ; and in such constitutions I have sometimes 
found that Plummer's pill, a combination of calomel 
and sulphur, and which in common practice no great 
dependence can be placed upon, has proved complete- 
ly successful.* 

It luckily happens, however, where salivation is thu£ 
easily excited that the symptoms of syphilis in general 
yield to a small quantity of mercury. Some of the 
worst symptoms of the disease will give way to a sali- 
vation induced by a very few grains of mercury. 
Even the uneasiness produced by nodes subsides at 
once on the salivation being fully excited. But it is 
proper to remark that this first effect of the mercury 
will not prove permanent if it be not followed out 
with farther quantities, given at such intervals as the 
state of the salivation will admit. I have repeatedly 
found, however, that this um\ be done with safety, 
even where a severe degree of salivation has previous- 
ly taken place. In one case of this kind, where there 

* Vide Appendix,. No. 21'. 



SeC. IT. JI\ LUES VENEREA. 1 73 

were deep venereal ulcers on the shoulder and on the 
head, as well as a node upon one of the bones of the 
fore arm, a violent salivation was excited by the ex- 
hibition of five mercurial pills, each of which con- 
jtained only one grain of mercury. This gave an en- 
tire check to the pain which accompanied the node T 
and to the progress of the ulcers, and although other 
five pills only were given the salivation was kept up 
for eight weeks, w r hen the sores healed and the cure 
was complete, no venereal symptoms having yet ap~ 
j peared, although several years have elapsed. 

In the progi ess of a long continued salivation tooth- 
ach and pains in the jaws and gums are apt to occur, 
and they add much to the distress of the patient. 
There is one advantage that we derive from giving 
mercury in a gradual manner ; by beginning with 
small quantities arid increasing them slowly the glande 
of these parts do not swell so suddenly, nor is the pain 
which ensues so severe as when too large doses are 
made use of at once. We also derive some advan- 
tage from keeping the parts moderately covered with 
thin flannel. There is no necessity for the head being 
so warmly covered as is eommonlv done, nor is it at 
all necessary where these pains do not take place; but 
when once they have occurred nothing proves more 
useful than moderate warmth. Indeed flannel seem? 
here to be equally useful as it is in the ordinary form of 
rheumatism ; from which, and from the resemblance 
which these pains to which patients taking mercury 
are liable in their jaws and head bear to rheumatic af- 
fections, I conclude that they are of the same nature. 

Before a patient enters upon a course of mercury, 
if there is cause to imagine that he will be long kept 
under it, and that a large quantity of the medicine will 
be necessary, w 7 e may save him a good deal of distress 
by inspecting his mouth and removing any teeth that 
are either very loose or much spoiled ; for teeth in this 
state never fail to give much pain when the full effect 
of ihe mercury upon the mouth has taken place. The 
points of teeth that are ragged ought also to be re- 
moved, as they are apt to produce painful and trouble 



174 OF THE REMEDIES USED Ch. IV. 

some ulcers on the contiguous parts as soon as they 
become much swelled. 

Ulceration of the inside of the cheeks and other parts 
of the mouth occurs also, and often in a very distress- 
ful manner from the mercury alone, where no teeth in 
this state can be discovered. The most effectual me- 
thod of preventing this is, to cause the patient, from 
the very first effect of mercury upon these parts, or 
even be lore this takes place, to wash his mouth several 
times a day, perhaps every two hours, with port wine 
and water, an infusion of red-rose leaves, or any other 
astringent. In this manner we strengthen the parts 
against the usual action of the medicine, and it also 
proves useful by preventing that foulness of the mouth 
which in every course of mercury is apt to take place. 
Fig tea and other emollients are commonly ^employed 
for this purpose, but I have not found that they an- 
swer so well as astringents. 

In speaking of the different preparations of mercu- 
ry we had occasion to iemark, that almost all of them, 
when given internally, are apt to injure the stomach 
and bowels. It is chiefly the bowels, however, which 
suffer from mercury, and they do so in some instances 
in a very alarming degree. The purging which takes 
place proves not only painful and debilitating, but of- 
ten exceedingly obstinate. At first the discharge 
consists chiefly of fceces, but afterwards these are mix- 
ed with slime, and often with considerable quanti- 
ties of blood. The patient is also apt to sutler from 
a very frequent tenesmus. 

From the similarity of symptoms we should be apt 
to imagine that purgatives might be equally servicea- 
ble here as in common cases of dysentery and diar- 
rhoea ; but we do not find this to be the case. We de- 
rive some advantage, however, from sheathing the 
intestines with a plentiful use of the farinaceous ve- 
getables, and animal jellies prepared with calves feet ? 
and shavings of heartshorn. Milk boiled to the consis- 
tence of a jelly with wheaten flour, or flour of rice, 
proves likewise an useful remedy. 



i SeC. IV. IN LUES VENEREA. 175 

Tn preventing this effect of mercury upon the intes- 
tines we derive most advantage from the patient being 
kept in a moderate and equable heat, and from his 
skin being preserved in a perspirable state, and so re- 
markable is the influence of this, that the slightest 
check to the discharge by the skin seldom fails of in- 
ducing purging. The fact indeed is so generally ad- 
mitted that I would not have taken this particular no- 
tice of it, if a contrary opinion had not lately been 
advanced, and from which much mischief might en- 
sue, were the practice to be adopted which it tends to 
inculcate.* 

Camphor proves sometimes useful in correcting this 
symptom. It may be given for this purpose to the ex- 
tent of eight or ten grains, three times a-day. Some 
of the absorbent earths, and kino, are occasionally 
used with advantage ; but opiates, particularly when 
thrown up by the rectum, are the remedies upon which 
we chiefly depend for removing the pain, and this is 
very commonly attended with a diminution of the dis- 
charge. When a clyster of thin starch and fifty or 
sixty drops of laudanum can be retained it seldom 
fails to give immediate relief, but where the tenesmus 
is severe whatever is injected by the anus is very apt 
to be instantly returned. In this case opium conjoin- 
ed with kino, in the form of pills, seems to be the best 
form of the remedy, 

It is here proper to remark, that although purging 
and gripes are frequent consequences of the internal 
use of mercury they are seldom observed during the 
longest mercurial course where unction only is em- 
ployed. When the course is conducted- in this man- 
ner loose stools may occasionally occur, but they may 
be generally traced to the effects of cold and damp- 

* Mr. John Hunter, whose ingenuity and abilities are only to be eqalled by 
his singular opinions, does not imagine that the operation of mercury can be 
affected by cold, not even by the patient being allowed to walk " in frost and 
snow." Mr. Hunter does not say that he has practised this method, and I 
cannot avoid observing that nothing should have warranted the publication of 
such an opinion but very ample experience of its being well founded. Vide 
Mr. Hunter's Treatise on the Venereal Disease, p. 349. 



176 OF THE REMEDIES USED Cll. IV, 

ness. I have seldom observed an instance of severe 
or obstinate diarrhoea from the external application of 
mercury, where the commencement of the purging 
could not be traced to some other cause. 

\\ hen none of the means employed for removing 
purging induced by this cause prove effectual, we are 
under the necessity of advising a temporary suspen- 
sion of the mercury, without which, indeed, all our 
remedies will frequently fail. 

Profuse sweating, I have already noticed as an ef- 
fect that sometimes ensues from mercury, and it ought 
to be guarded against with much attention. Nothing 
tends more to induce debility and injure the constitu- 
tion than a long continuance of this symptom. 

The most effectual method of preventing sweating 
is to avoid much warmth, so that patients are seldom 
hurt with it who pay due attention to the heat of their 
apartments. It was formerly the practice to con- 
fine patients under mercury to small apartments ; to 
prevent as much as possible all kind of access to the 
external air ; and to have the bed placed by the side 
of a large fire. These measures prove detrimental in 
different ways, and they seldom fail to excite a con- 
stant and profuse perspiration. The most effectual 
method of preventing this is, to keep the patient in 
an equal moderate temperature, in a large apartment, 
and even to admit of his going from one apartment 
to another, which, in most instances, may be done 
with safety. A nourishing diet, a moderate allowance 
of wine, the free use of Peruvian bark, and of the vi- 
triolic acid, are the most effectual remedies against 
this effect of mercury. But nothing proves successful 
where the apartment is kept too much heated. 

In some cases the kidneys are particularly acted up- 
on by mercury; but the discharge of urine which it 
excites is seldom so great as to injure the patient. 
Were it ever to do so, the remedies commonly em- 
ployed in diabetes would be advised, and of these the' 
most effectual perhaps that we could give, would be 
such as operate by promoting a diaphoresis. 



SeC. IV, IN LUES VENEREA, J 77 

It is not an uncommon effect of mercury to excite 
an eruption upon the surface of the body. In some 
this appears as a miliary rash, somewhat resembling 
measles ; while in others it is considerably elevated and 
seems to be produced by a serous effusion between the 
cutis and scarf skin. In some the eruption is partial, 
being confined to particular spots, while in others it 
prevails generally over the whole body. 

This eruption or efflorescence is not attended with 
pain, but the heat and itchiness which accompany it 
are in some instances so distressful that it keeps the pa- 
tient at all times very uneasy, and deprives him en- 
tirely of rest. 

The remedies which I have found to answer best 
are the internal use of opiates, conjoined with the ap- 
plication of flour, or starch-powder to the parts affect- 
ed. The skin is kept sufficiently cool and easy by 
one or other of these powders being from time to time 
freely applied to the eruption; and by a proper exhi- 
bition of opiates we secure rest during night. In some 
instances, however, we are obliged to avoid the use 
of opiates ; for although they may answer the pur- 
pose of procuring sleep they tend evidently to in- 
crease the heat and itchiness of the eruption. We 
find, indeed, that in some constitutions opium excites 
an uneasy itchy sensation over the whole body, even 
where no irruption has previously taken place; and it 
is perhaps with such patients only that it cannot be 
employed in the treatment of this eruption. 

The eruption to which I allude appears to arise en- 
tirely from the effect of the mercury upon the system; 
but it does not seem to depend on any particular pre- 
paration of the remedy. It takes place indiscrimi- 
nately from all of them, and not more readily from 
unction than from these preparations that are used 
internally. But there is a kind of eruption of a local 
nature, produced entirely by the friction employed 
in the application of unction. This appears in the 
form of distinct pustules, which in some are accompa- 
nied with a good deal of uneasiness, while in others 

vol. ir, 23 



17& OF THE REMEDIES USED Cll. IV. 

they produce no kind of distress. No remedy proves 
of any avail while the application of the oinhii'-nfc 
is continued, but the eruption may always be pre- 
vented by the precaution we have formerly ^iven, of 
not applying the friction in daily succession to the 
same part. 



Mr. Pearson does not place much confidence in the efficacy of the 
articles mentioned by our author, (Lime Water, 8tc.) for the remo- 
val of salivation, but recommends a discontinuance of the mercury 
for a time, a free exposure to cool dry air, the occasional use of 
cathartics; the Peruvian bark and mineral acids, with the assiduous 
application of astringent gargles. The only danger to be appre- 
hended from this course is a sudden suppression of Ptyalism, which 
is often productive of serious consequences. In a case related by 
Dr. Silvester, the patient was unable to retain hardly any food in her 
stomach for the space of three months, and Mr. Pearson has ob- 
served not only violent pains, but general convulsions produced from 
this cause. This however cannot be attributed to a cool and dry air, 
since it has occurred in patients confined to a warm temperature, but 
rather originates from exposure to cold and moisture. The remedy 
for this suppression is a quick introduction of mercury into the body, 
so as to produce a soreness of the gums, with the occasional use oi 
the hot bath. 

When the ptyalism is accompanied with ulceration of the tongue, 
of the cheeks, or of the tonsils, Mr Pearson has found that by sus- 
pending the use of mercury, and exhibiting the sulphuric acid dilu- 
ted three or four times a day? a very speedy amendment was produ 
eed. Mortification is sometimes a consequence of this complaint, 
and in this case we would recommend the application of blisters,, 
as pointed out by Dr. Physick : That sudden and violent rushing to 
the mouth of which Mr. Bell speaks, when even the smallest quan- 
tity of mercury is exhibited, is often relieved by the application oi 
pounded ice to the jaw, and the use of cold acidulated gargles, ca- 
thartics and blisters, are also sometimes advantageous. 

In cases of diarrhoea or dysentery originating from the use of rncr 
cury, the exhibition of opium, not only in the form of clysters, but 
by the mouth, is the most efficacious remedy. 

Mr. Pearson states that in the course of two or three years after 
his appointment at the Lock Hospital, he observed almost ever) 
year, one or two cases of sudden death among the patients, without 
any assigned cause, and the subjects were commonly persons who 
had nearly and sometimes entirely finished their mercurial course. 
On enquiring of his colleagues Messrs., Bromfield and Williams, they. 
acknowledged themselves ignorant of the cause, mode of pre- 
vention* or treatment of the disease, and remarked that they had 
never discovered any morbid appearances in the bodies of those who 
had died thus unexpectedly. Mr. Pearson alter diligent attention 



See. IV. IN LUES VENEREA. %7§ 

ascertained that these effects were owing to mercury acting as a pois- 
on on the system, quite unconnected with its agency as a remedy, 
^nd its deleterious qualities, were neither in proportion to the in- 
flammation of the mouth, nor to the actual quantity of that mineral 
absorbed into the body. This morbid condition of the system he has 
denominated Mercurial Erethismus, and Observes that it is charac- 
terized by great depression of strength, a sense of anxiety about the 
prascordia, frequent sighing, trembling partial or universal, a small 
quick putee, sometimes vomiting, a pale contracted countenance* 
a sense of coldness, but the tongue is seldom furred, nor are the vi- 
tal or natural functions much disordered. A sudden or violent exer- 
tion of the animal power has, when these symptoms are present,- 
generally preceded the sudden death of the patient. To prevent its 
dangerous consequences it is necessary immediately to discontinue 
the use of mercury, whatever may be the state of the venerea! 
symptoms. The patient must be exposed to a dry cool air, in such 
a manner as shall be attended with the least fatigue. He ought to 
be taken into a garden or field and live as much as possible in the 
open air. This mode of treatment will often relieve him in the space 
of from ten to fourteen days, and Mr. Pearson observes that he nas 
ficarcely lost a patient since he first adopted it. What may appear 
remarkable, lie adds, is that the persons amicted with it can very 
soften employ mercury efficiently afterwards, without suffering any 
inconvenience. (Pearson on the effects of various articles in thft 
cure of Lues Venerea, 1st Edit. 1800. P. 130 — 3.) 

In the early stage* of the Erethismus, its further progress ac 
cording to Mr. Pearson, may be frequently prevented by exhibiting 
the Camphor mixture, with large doses of the volatile alkali, sus- 
pending at the same time the use of mercury. Also when the 
stomach is not oppressed by sarsaparilla, this medicine is produc- 
tive of infinite benefit. (Rees' Cyclopedia, Art. Erethismus, in 
which the writer quotes the second edition of Mr. Pearson's work.) 

In the concluding paragraphs of this section, Mr. Bell has given 
the first printed account of a disease which of late years has excited 
great attention among medical men. This honour is universally al- 
io- sd lam, although Mr. Pearson asserts that he has been in the 
hi it of describing it, since the year 1783, in his Lectures on Sur- 
gery, and that he became ..cquainted with it in 1781. Cases have 
also been observed as early as the year 1798, in the Royal Infirmary 
of Edinburgh. It was however far from being familiar to practition- 
ers until the year 1804, when it was described by Dr. Thomas 
Spens of Edinburgh, under the name of Erythema Mercuriale in 
the Edinburgh Med. and Surg. Journal, vol 1. p. 7. by Dr. Moriar- 
tv. of Dublin, under the name of the Mercurial Lepra, and by Dr. 
Aiiey, his countryman, in u an Essay on a peculiar eruptive diseasej 
arising from the exhibition of mercury." The latter gentleman, in 
1804, assigned to this complaint the appellation of the Mercurial- 
Jjisease, but in 1810, gave it in a new edition the name of Hydrar- 
gyria. The term used by Dr. Spens was adopted by Dr. McMullin 5 
in his Essay on this disease in the Edinburgh Med. and Surg. Journ= 
■al for January, 1806, and in 180f, Mr. Pearson published an ao 



I BO OF THE REMEDIES USES) Ch. IV. 

count of it under the appellation of Eczema Mercurials, in the se- 
cond Edition of his work on the effects of various articles in the 
cure of Lues Venerea. — The above, is we believe, a complete 
list of writers on this subject, particularly as Mr. Mathias* work on 
the Mercurial Disease more properly relates to that class of com- 
plaints which of late years has been described under the name of 
Diseases resembling Syphilis. 

Dr. McMullin commences his Essay by observing that eruptions 
of various kinds are very common symptoms of syphilis, but a 
very unusual effect of mercury. In consequence, until the real 
nature of the erythema was discovered, it was considered an anom- 
alous form of lues venerea, and mercury was given to a greater ex- 
tent than before, thus applying the cause of the disease for its re- 
moval, and aggravating all its symptoms. The observation of this 
fact, together with another of less frequent occurrence, namely, a 
similar eruption appearing inpatients using mercury for other com- 
plaints, and in whom no suspicion of syphilis could be entertained 5 
at last led to the important discovery) that the eruption was entire- 
ly caused by the mercury, and not at all connected with the origin- 
al disease.' 

The following account of the symptoms of Erythema Mercuriale, 
we extract from Dr. McMullin's valuable Essay. " The different 
appearances," he observes, " which this disease assumes, accord- 
ing to its severity and duration, will be best understood by describ- 
ing it ys consisting of three distinct stages. 

Tue first stag j commences with languor, lassitude, and cold shiv- 
crings ; tnese symptoms are succeeded by increased temperature of 
the oody, quick pulse, nausea, head-ach, and thirst. The patient 
is troubled with a dry cough, and complains of difficult respiration, 
anxiety, and sense of stricture about the praecordia. The tongue is 
usually moist, and covered with a white glutinous slime ; it some- 
times appears clean and bright red in the centre, whilst the margins 
remain foul. Tne skinfeeis unusually Hot and itchy, with a sense 
of ^rickiing, not unlike the sensation experienced from the appli- 
cation of nettles. Tne belly is generally costive, but a diarrhoea is 
often produced by very slight causes. 

On tne first or second day an eruption most commonly shows it- 
sell, the colour of which is either dark or bright red : thepapu.ae 
are at first distinct and elevated, resembling very much those in ru- 
beola. Sometimes, but rarely, the eruption appears like urticaria, 
and in such instances the disease is observed to be very mild. The 
papulae very speedily run together in such a manner as to form a 
sutfused redness, which disappears on pressure. In most cases it 
begins first on tne scrotum, inside of the thighs, fore arm, or where 
mercurial friction had been applied, and the integuments of the 
parts affected become much swoin. There have also been observ- 
ed instances where an eruption of a purplish colour, and unaccom- 
panied by papulae, has diffused itself suddenly over the entire body. 
This, however, may be considered as uncommon. In every instance 
winch came under my observer on, it was confined at first to a few 
places, and from thence gradually extended, untU the different poi- 



Sec. IV. IN LUES VENEREA, 181 

tions of the eruption had united, and the papulse were also rough to 
the feel. But in those cases which resemble urticaria, a number of 
minute vesicles, which contain a serous fluid, appear, from the 
commencement, interspersed among the papulae. Contrary to what 
happens in most diseases accompanied with cutaneous affections, 
the febrile symptoms are much aggravated, and continue to increase 
after the eruption has been completed. The pulse in general beats 
from 120 to 130 in a minute, the thirst continues urgent, and the pa- 
tient, extremely restless, seldom enjoys quiet sleep. When the 
eruption has continued in this manner for a certain period, the cuti- 
cle begins to peel off in thin, whitish, scurfy exfoliations, not un- 
like those observed in rubeola. This- desquamation has not been 
attended to by Dr. Moriarty or Mr. Alley, if they have not, by giv- 
ing the same name to the decrustation which occurs in the last stage* 
confounded both together. It commences in those places where 
the eruption first made its appearance, and in this order spreads to 
other parts. About this period the fauces become sore, the tongue 
swells, and the eyes appear somewhat inflamed. 

The duration of this stage is very various ; sometimes it contin- 
ues from ten to fourteen days, and in other cases it terminates in 
half that time. When the disease has appeared in its mildest form, 
the patient recovers immediately after this desquamation, a new cu- 
licle having formed underneath ; but, if severe, he has only experi- 
enced the smallest part of his sufferings, and the skin now assumes 
a new appearance, which I have considered as the second stage. 

The skin at this period appears as if studded with innumerable 
minute vesicles, which are filled with a pellucid fluid. These vesi- 
cles maybe expected, if the patient, at the close of the first stage, 
complains of increased itching, and sense of burning heat, in those 
parts from whence the cuticular exfoliations have fallen. They re- 
main sometimes for a day or two, but are most commonly burst, im- 
mediately after their formation, by the patient rubbing them, in or- 
der to relieve the troublesome itchiness with which these parts are 
affected. They discharge a serous, acrimonious fluid, which pos- 
sesses such a very disagreeable odour as to induce nausea in the pa- 
tient himself, and those who approach near his bed-side. The odour 
is so peculiar, that it can easily be recognised by any person *vho 
has once experienced it. 

This fluid is poured out most copiously from the scrotum, groin, 
inside of the thighs, or wherever the skin forms folds, and sebace- 
ous glands are most numerous. The serous discharge from these 
minute vesicles form, with the cuticle, an incrustation, which may 
be considered as the third or last stage. 

These crusts are generally very large, and, when detached, retain 
the figuie of the parts from which they have fallen. Their colour 
is yellowish, but sometimes appears dark and dirty. This period 
of the disease might be termed, I think, with much propriety, the* 
stage of decrustation, in order to distinguish it more fully from the 
desquamation which has been already noticed. From the use of the 
two last terms indiscriminately, those who have described the dis- 
ease have introduced into their descriptions a degree of confusion, 



182 OF THE REMEDIES USED Ch. IV. 

•which has caused its progress not to be well understood. When this 
stage appears, the fauces become more affected, the eyes intole- 
rant of light, and the tarsi tender, inflamed, and sometimes invert- 
ed. The crusts formed on the face, as in other parts of the body, 
before falling off, divide asunder, so as to leave cracks and fissures, 
which produce an hideous expression of countenance; and the eye- 
lids are also, from the general swelling of the face, completely clo- 
sed. The back and hairy scalp are last affected, and, even in very 
severe cases, these parts are sometimes observed to escape entirely. 
The patient, whilst in this state, is compelled to desist from every 
kind of motion, on account of the pain which he experiences on the 
slightest exertion, and which he describes as if his flesh were crack- 
ing. The crusts also fall off in such abundance, that the bed ap- 
pears as if strewed with the cones of hops. Whilst the eruption is 
only making its appearance in one place, another part may have ar- 
rived at its most advanced form; so that all the different stages of 
the disease may be present at one time in the same individual. It 
is attended with typhus through its entire course ; but it is very cu- 
rious to observe, that the appetite for food, in most cases, remains 
unimpaired, and sometimes is even voracious. This circumstance 
was particularly remarkable in a patient who laboured under the dis- 
ease, in its worst form, for the space of three months, in the Royal 
Infirmary of Edinburgh ; for double the usual hospital allowance of 
food was scarcely sufficient to satisfy his hunger. When the catarrh- 
al symptoms have continued during the progress of the compiaint, 
they are, at this advanced period, particularly aggravated: the anx- 
iety and pain of breast are also very severe, attended with cough, 
and bloody expectoration, and the patient always feels languid and 
dejected. The pulse becomes frequent, feeble, and irregular, the 
tongue black and parched, and at length diarrhoea, delirium, con- 
vulsions, gangrene of the surface of the body, and death, super- 
vene. In its mild form, it only goes through the first stage, and 
terminates, as we have already stated, in a few days, by a slight de- 
squamation. But, when severe, it is often protracted more than 
two months, every stage of the eruption continuing proportionably 
longer; and when, in this manner, it has run its course, it repeated- 
ly Wreaks out on the new surface, and passes through the same 
stages.' 5 

To the above we add an abstract of Dr. Alley's work, taken from 
>hc New-England Journal of Medicine and Surgery, for April, 1814. 

" The Hydrargyria," as Dr. Alley states it, *« is characterised 
by an eruption, which is very variable in its appearance. These va- 
rieties in the appearance of the eruption being usually accompanied 
with corresponding symptoms indicative of the medicines or pecu- 
liarity of the disease, justify the division of it into three species. 

1 . Hydrargyria mitis vel sine febrc ; 2. hydrargyria simplex febri- 
lis ; 3. hydrargyria maligna. 

1. Hydrargyria mitis. This species has at a first view nothing to 
characterize it further than a light rose coloured efflorescence ; an 
nttentive observer, however, by holding the affected parts between 
feim and the light, and keeping his eye on a level witfi them, may 



Scc.it. in lues venerea. J 83 

perceive the surface to be studded over with innumerable, minute, 
and transparent wrinkles ; but to the naked eye the vesicular ap- 
pearance is sometimes with difficulty perceptible, Heat and itching 
attend the striking out of the eruption, and slight headach and nau- 
sea, in some cases, exists for a few hours. At times the smarting 
itching which attends the striking out of the eruption is not contin- 
ual, sometimes attended with accelerated pulse, and Hushing of the 
face. 

The efflorescence though not close at first, is gradually diffused 
over the parts affected, viz. upper part of the thighs, groins, scro- 
tum, lower part of the abdomen, &c. and it usually is confined to 
these parts. If, however, mercury be used after its appearance, 
it does not long remain local, the colour of the eruption in this is 
sometimes as dark as in the second species ; the spots are minute 
and distinct however, unless the use of mercury be persisted in af- 
ter their appearance. In this as in the other species, the colour of 
the eruption recedes on pressing, and suddenly returns, when the 
pressure is removed, and the finger will readily detect an inequality 
of the surface. At times the efflorescence fades away without any 
desquamation, when however the vesicular appearance is very man- 
ifest, a slight scurfiness may be observed after a few days, and the 
natural colour in some instances is net regained for some time after 
the desquamation has commenced. This species by an incautious 
use of mercury while it exists may degenerate into the second, and 
even third, or be produced in an aggravated form by a too early re- 
moval of the mineral. This is however, contrary to Mr. Pearson's 
experience who states that u it has even occurred where the patient 
has been sent out of the hospital that he might enjoy the benefit of a 
pure atmosphere." 

2. Hydrargyria simplex-febrilis. The eruption in this species is 
preceded by fever, it is accompanied with itching of the skin, audis 
considerably more rough to the touch than the efflorescence in the 
same species. From being distinct the spots soon become crowded 
together, and after the third day the natural colour of the skin can- 
not be discerned. This eruption may be distinguished from measles 
by the spots being larger in the former, and not appearing in the 
annular form which is the case with measles. 

Mr. Crampton, however, thinks it very difficult for the first two 
days to distinguish them, the eruption is of a dusky reddish hue, 
and if mercury be laid aside it is seldom darker than on the second 
day. The parts attacked are various, in males sometimes the scro- 
tum, thighs, sometimes however, the backs of the arms and hands,, 
or the back and abdomen are first affected, contrary to what occurs 
however, in the first variety, it gradually spreads over the entire 
surface of the body. In this species at times the vesicular appear- 
ance of the first, may be noticed, especially on the first striking out 
of the eruption. When on the decline the eruption may be mista- 
ken for the last of scarlatina anginosa, at a similar period : the dusk- 
iness of colour which it always preserves will- enable a careful ob- 
erver to distinguish them. 

This species maybe distinguished from the first, by a greater sep- 



184 OF THE REMEDIES USED Cll. IV* 

aration of the cuticle. This is usually preceded by soreness of the 
throat and fauces. This latter symptom is of short duration. De- 
squamation generally commences on the fourth day of the eruption* 
and the earlier it occurs the milder in general the disease. It has 
been observed, that successive desquamations at times take place, 
and that this is chiefly observable incases in which mercury has been 
Used after the formation of the disease. 

The febrile symptoms mentioned as the precursors of the erup- 
tion are followed by a considerable degree of oppression about the 
prsecordia, a hard cough and difficult respiration. The skin is usu- 
ally very dry. heat very great; from 102° to 106° and is in no dis- 
ease perhaps more steady or permanent. Sometimes, indeed, in 
this species, a very foetid perspiration takes place, where there is 
much attrition of surface, as in the axilla, Sec. 

The pulse, though full, is not in general hard and varies from 
100° to 130° in the minute. The febrile symptoms, except the 
headach and nausea, increase as the disease proceeds, and does but 
seldom abate with the desquamation. The eleventh clay has hither- 
to been considered critical. 

3. Hydrargyria maligna. This species is ushered in with the 
same symptoms as the last. But Mr. A. considers the following as 
almost certain indications of the distressing nature of its termina- 
tion. 1. The sense of burning on the surface is experienced to a 
very painful degree. 2. The actual heat of the skin becomes- in= 
tense. 3. The soreness of the throat and fauces is extreme. 4 The 
colour of the eruption is darker, rising sometimes even to purple, 
and there is considerable tumefaction of the surface. 5. Vesicles 
of a larger size than in the former species precede desquamation. 

It must be remembered, that the other species may degenerate 
into this, by continued use of mercury, and even by continuing the 
patient in the venereal ward of a Hospital. A most painful burning 
sensation accompanies the tumefaction, and immediately preceding 
desquamation the heat has risen to 108°. Blisters are now formed 
and discharge an acrimonous lymph. So numerous are the vesi- 
cles that the whole cuticle desquamates from the tumefied parts, as 
in that species of Roseola attendant or small pox. As the disease 
advances, the discharge acquires a most offensive odour, one which 
will be readily recognized, after having been once experienced. 
The discharge also becomes more acrid and viscid. Desquamation 
is later in this than in the other species, not occuring in some cases 
till the tenth day. The separation commences with cracking of the 
scarf skin, scabs form on the surface. The eyelids partaking of the 
general tumefaction are sometimes closed ; and so irritable at times 
is the surface, that blood instead of lymph attends the desquama- 
tion. The cuticle sometimes separates in large pieces, thus, that 
of the hand will come off, so entire as to resemble a glove. 

The desquamations which succeed,' discover a surface less red, 
and exposed, and the discharge ceasing the epidermis is renewed. 
Painful tumours sometimes occur in different parts of the body, they 
suppurate and heal kindly;. While desquamation is only commen- 



SeC. IV. IN LUES VENEREA^ 183 

cing in some parts, a thin acrid matter often exudes in others. The 
cuticle also when regenerated at times cracks, and separates again ; 
and in some cases, after the disease has disappeared in every other 
part of the body, one particular place remains discoloured and ex- 
tremely sore. The cuticle, in some severe cases of this species, 
is not the only part separated ; but so deep does the desquamation 
extend, that in one patient who was very much pitted with the small 
pox, no pits were discoverable after his recovery. In other instan- 
ces the hair from the chin, axilla, Sec. has been completely removed 
by the desquamation. Dr. Alley observes, that the febrile irritation 
is, in general, proportionate to the severity of the external symp- 
tom. The affection of the lungs is among the first and most dis- 
tressing symptom. In some cases great sense of weight and op- 
pression about the pragcordra and difficult respiration are the most 
distressing ; in others hard and incessant cough, and a fixed pain in 
the chest are superadded. The pulse is hard as in pneumonia ; and 
during fits of coughing, severe headach is experienced. Delirium 
has not been observed. The soreness of the throat is very distress- 
ing in some cases for many days, sometimes hoarseness and hae- 
morrhage from sloughing of the lining membrane of the fauces has 
occurred. At first the tongue is white, it becomes however parch- 
ed, and black in the centre, towards the conclusion. The pulse 
continues quick, but loses its fulness ; it becomes weak and fre- 
quently irregular. The secondary fever is the most dangerous, and 
is so in proportion to the extent of the disease and the depths of the 
desquamation. True hectic at times occurs in these cases, andfre- 
q lentiy diarrhoea supervenes, constituting the most formidable 
■symptom of the disease. Convulsions sometimes occur, andatoth- 
eis the fasces and urine are discharged involuntarily. 

As tne hydrargyria has been mistaken for other diseases, Dr. A. 
subjoins the following brief recapitulation of its most leading feat- 
ures. 

1. The eruption is, for the most part, at first vesicular. 

2. The fever and eruption are generally synchronous in their ap- 
pearance. 

3. Exfoliations of the cuticle usually take place, about four days 
after the appearance of the eruption, and is commonly preceded by 
soreness of the throat and fauces. 

4. In several cases, blisters, sometimes large vesications pre- 
cede desquamation. The cuticle, in such case's, cracks and forms 
fissures ; and the odour of the exudation from the surface, is strong- 
ly characteristic of the disease. 

5. The presence of the delirium ferox has never been witnessed, 
however considerable the inflammation a^d tumefaction of the ex- 
ternal parts of the head ; nor has the head appeared engaged, ex- 
cepting where the debility was extreme and the exudation from the 
surface profuse. 

6. When the cuticle desquamates, the parts underneath appear 
red, as before that occurrence. 

7. The disease is »eyer fatal unless secondary fever supervene 
VOL. IT, 24 



186 



OF THE REMEDIES USED 



Cll. fV. 



Dr. Alley gives the following table of the results of all the cases 
that he has witnessed during- the last ten years. 





Hydrargyii 

Mitis. 


H Simplex 
f'ebrilis. 


H. Malig- 
na. 


Total. 


Cured. 


Died. 


Male. 


6 


12 


10 


28 


22 


6 


Female 


4 


7 


4 


15 


13 


■ 2 


Total. 


10 


19 


14 


43 


35 


8 



Mr. Pearson however, has never seen it fatal, nor has he seen it 
in subjects above 50, and says, that its occurrence is more common 
about eight or ten days after beginning a mercurial course. 

The remote cause of this disease, is the employment of mercury 
and this without reference to the quantity or manner in which it is 
used. " I have seen the eruption'* says Mr. Pearson, " take place 
after the friction of a single drachm of mercurial ointment and af- 
ter one dose of calomel. I have known a slight degree of the ecze-* 
una mercuriale, induced in young children from the administration 
of a single grain of calomel, the touching any part of the human 
body with mercurial ointment will sometimes produce it and I have 
seen the accidental falling of a few grains of the hydrargyrus nitra- 
tus ruber upon the skin, succeeded by a similar effect, but under 
these circumstances, the eruption will be confined to the parts with 
which the mercurial preparation comes in contact." (London Med- 
ical Review, vol. 3. p. 315.) Practitioners however appear to differ 
on the point whether the application of cold to the body, when un- 
der the influence of mercury, is necessary for the production of the 
disease. This is the opinion of Dr. Gregory and Dr. McMullen 
inclines to this belief, in consequence of the constant combination 
of catarrhal symptoms. Dr. Spens remarks that in all his cases, 
the patients had been exposed to cold, but adds that something 
more is necessary for the production of the disease, since its occur- 
rence is too rare to be the necessary consequence of a cause so com- 
mon. Mi". Pearson however considers the irritation of mercury to 
be the exciting cause, independent of the action of cold, which he 
denies having any effect in bringing on the complaint. 

For the removal of this disease Dr. McMullen recommends the 
Immediate discontinuance of mercury, the removal of the patient 
irom wards, where this mineral is in use ; the frequent use of tepid 
bathing; emetics and diaphoretics, but on account of the irritable 
state of the bowels, he prefers theacetite of ammoniac or citrate of 
potash to antimoniais ; and purgatives of tne mildest kind, such as 
oleum recini, magnesia vitrioiata, Sec. To aliay the cough and sore- 
ness of the fauces, he advises mucilaginous drinks with opium. 
He recommends great attention to cleanliness and is opposed to lo- 
cal applications of an astringent kind to the eruption and also to the 
use of blisters. In the second stage, when the lever assumes more 
of a typhoid type, the cola infusion of bark with opium maybe tri- 
ed, but it generally disagrees with the stomach. Wine and porter 



SeC. IV, IN LUES VENEREA. 1 8*7 

are very useful, as are large quantities of diluents and tenid ablu- 
tion. To relieve the ophthalmia tarsi, the uuguentum oxidi zinci 
will in general prove sufficient, and to. appease the painful sensation 
of the skin cracking, the linimentum aquse calcis, which should be 
applied as soon as crusts appear. 

The method of cure adopted by Dr. Spens is in general similar 
to the above. He observes that the external applications which he 
found most useful were lime water and flour. 

Mr. Pearson seems doubtful whether any mode of treatment has 
the power of interrupting the regular course of the disease, or 
abridging its duration. Believing however in the benefit of reme- 
dies to mitigate it, he recommends in the early stage, small doses 
of antimonial powder, with saline draughts or the ammonia acetata. 
A gentle purgative should be given every three or four days and 
opium to procure sleep, and the latter article may be advantageous- 
ly combined with camphor. Sarsaparilla with bark may be given, 
when the discharge is no longer ichorous and the tumefaction is sub- 
siding. He has also found the sulphuric acid to prove grateful and 
refreshing. The diet should be light and nourishing, but no fer- 
menting liquors should be allowed until the desquamation has some- 
what advanced. Frequent use of the warm bath and often changing 
the linen and sheets of the patient are indispensable'. Mr. Pearson 
also covers every part from which the cuticle is detached, with a. 
mild cerate of litharge plaster* . yellow wax and olive oil, spread 
thickly on rollers, and renewed twice a day. This mode of treat- 
ment, he has, during twenty years experience, found successful, 
(Rees' Cyclopedia, Art. Erythema Mercuriaie.) 

Dr. Alley agrees with Mr. Pearson in the opirikhi, that medicines 
have no effect in cutting short the disease, but objects most decided- 
ly to the remark of the latter gentleman, that in some cases, the 
continuance of mercury is proper. Dr. Alley advises the imme- 
diate discontinuance of mercury, tepid ablution in the eruptive stage 
and some gentle purgatives, for the removal of the pectoral symp- 
toms. This plan he considers proper during the eruptive stagje of 
each of his species. He recommends the culd affusion, but does 
not appear to have used it in any of his patients, blood-ietting where 
the inflammatory symptoms are severe; and diuretics especially 
digitalis, after evacuations. Emetics do not appear to be indicated, 
and the mineral acids although useful in the primary stages ought 
to be laid aside in the secondary one, unless combined with opium, 
as diarrhoea is generally present. The same objection occurs to 
the use of bark, which also aggravates the pectoral symptoms and 
Dr. Alley has found wine an excellent substitute in the latter stages 
of the disease. As to external applications the author speaks well 
of the liniment : aq : caic : and also of finely levigated carbon ; 
zinc: pp. or meal, separate or in a combined form. He deprecates 
the external use of lead a^d considers it highly prejudicial. (Lon- 
don Med. Review, vol. 3. p. 317. Eclectic Repertory for October, 
1813, and New-England Journal for April, 1814.) 

With respect to the controversy an the name which ought to be 
given to this disease, we refer our readers to the works quoted 



388 OF TH~E REMEDIES USED Cb. IV. 

above. It is proper however to observe that Dr. Rutter of Liver- 
pool, has published a case of erythema not occasioned by mercury, 
in the Edin. Med. and Surg. Journal for A> Hi, 1809, aid Dr. Mar- 
cet of London, another in the Medico Ghirnrgital Transactions, vol. 
'2. (New-England Journal, vol. 1. p. 304) Tbe latter gentleman 
suggests the term Erythema ichorosum as more suitable than that 
of Erythema mercuriale. It appears that this disease is not confined 
to Europe, since in a letter from a surgeon in Madras (Edin. M and 
S. Journal, for Oct. 1806) it is stated that among the natives, who 
never can be made to clothe themselves sufficiency, when under the 
use and influence of mercury, the disease occurs frequently and of- 
ten proves destructive. 

Dr. Wilian in his work on the Diseases of the skin, mentions a 
complaint under the name of Erythema jiafiulatum, which he is in- 
clined to refer to the use of mercury. It occurs lie observes, at an 
advanced period of the Lues Venerea on the upper and inner part 
of the thighs, on the scrotum and between tne nates. It is attended 
with heat, pain and itching, and an acrimonious viscid discharge, 
which partially excoriates, but which at length forms a smooth whi- 
tish incrustation, ovei all the affected surface. The best remedies 
arc washing the parts with warm soap and water, and applying soft- 
astringent ointments. Dr. Wilian has also known the Pomfiholy& 
berdgnus induced by the use of a few grains of mercury. (Wilian 
on Cutaneous Diseases, vol. 1st. London, 18 8.) 

Madness is not a very uncommon consequence from the exhibition 
of mercury, largely and injudiciously administered. Mr. Hasiam 
in his work on Insanity, sates tnis among other causi s, and Baron 
Larrey in his Relation Chirurgicale cie PArmee D 'Orient observes, 
that although syphilis was very easily cured in Egypt by the internal 
use of mercury, diaphoretics and valour baths, yet mercurial fric- 
tions were not only insufficient, but produced violent frenzy in some 
patients, and spasms, convulsions and profuse salivation in others. 
(Edin. M. and S. Journal for April, 1806.) It is a fact, indeed, 
well attested, that in warm climates, a smaller quantii) of mercury 
and a shorter period of time are sufficient to cure the disease. Tnis, 
%ve have observed is the case in Egypt, and Mr. Pearson states the 
same to occur in Italy, Spain and the Southern parts of France. 

Ed 

IX. JDocs Mercury ever fail in the Cure of Lues 
Venerea ? 

This is a question of the highest importance, and 
therefore merits our attention. 1 am disposed lift an 
the result ol my own experience to say, that menu- 
ry under proper management may be considered as a 
certain remed) for syphilis, when not combined* wi.r.h 
other diseases, or where it does not ahect patients 



SCO. IV, IN LUES VENEREA. 189 

whose constitutions are so reduced and debilitated as 
to prevent the quantity of the medicine that is neces- 
sary to destroy tie virus from being employed. I 
know that some are of a different opinion ; but I con- 
clude that they are wrong; from my never having 
met with an instance of mercury having failed when 
it was properly given, but where some obvious rea- 
son, such as i have mentioned, could be assigned 
for it, 

Lues Venerea as we have already had occasion to 
see, is often combined with diseases in which mercu- 
ry commonly does harm. This is particularly the 
case in scurvy, and in some degree with scrophula. In 
the higher degrees of scurvy mercury cannot be giv- 
en but with great danger ; and even where it prevails 
in a slight manner only, mercury cannot be employ- 
ed in such quantities as are sufficient for eradicating 
any of the more formidable symptoms of Lues Vene- 
rea. When the two diseases therefore are conjoined 
we cannot expect that mercury will have much influ- 
ence in the cure of any venereal symptoms that may 
take place ; and I believe that we are often disappoint- 
ed in the treatment of the disease by the patient at the 
same time labouring under a certain degree of scur- 
vy, which although not so obviously marked as to in- 
dicate the propriety of advising an antiscorbutic regi- 
men, may yet be sufficient to prevent him from 
receiving the full advantage of a course of mer- 
cury. 

I conclude this to be the case from the frequent in- 
stances of the failure of mercury in the cuie of many 
of the symptoms of syphilis, in which it afterwards 
proves successful when the constitution of the patient 
has been restored from a weak debilitated state to 
strength and firmness, and which we usually accom- 
plish by a milk and vegetable diet, country air 9 and 
such other articles of regimen as generally contribute 
to remove even the high degrees of scurvy. 

Nay, I believe that a mercurial course when long 
protracted, is apt to irduce a certain degree of that 
very state of the sysiem which I now allude to, and 



190 OF THE REMEDIES USED Gil. VI. 

which T conceive to be the cause of the remedy being 
often found to fail where in this manner it has been 
long continued. Every practitioner is acquainted 
with tills circumstance, that a variety of venereal 
symptoms, and more especially extensive ulcers, will 
to a certain length do well under mercury, when af- 
ter a great deal of the medicine has been exhibited 
they will begin to remain stationary, and make no 
progress whatever, although the mercury should be 
given in larger quantities than at first. Nay, in some 
instances they become worse. The discharge from 
the ulcers, instead of being mild and purulent, as for 
some time it may have been, will become thin, sharp, 
and, corrosive, and the sores themselves more exten- 
sive. In this situation a farther continuance of mer- 
cury very commonly does harm, whilst the most ob- 
vious advantages are derived from it after the consti- 
tution of the patient has been restored by the influ- 
ence of a proper regimen. We even sometimes find 
that a cure is accomplished by regimen alone, and that 
no more mercury is required, but this can only hap- 
pen where a sufficient quantity of the medicine has 
been previously given for the destroying the virus of 
the disease, and where the ulcers which remained 
were kept up by a state of the system, which mercu- 
ry, instead of removing, seems evidently to promote. 
In the commencement of a mercurial course, and for 
some time thereafter, it is a certain effect of mercury 
to excite inflammation, and to produce that state of the 
system which we conceive to be the very reverse of 
what takes place in scurvy. The pulse becomes full and 
frequent, and the blood is firm and sizy ; but all who 
have paid attention to the subject will have perceived 
that the contrary happens where mercury has been, 
long continued. The patient, however full he may 
have been, is for the most part much emaciated: his 
pulse is feeble, and any febrile symptoms to which he 
may be liable are of the low or putrid kind. The 
particular state of the blood in this situation we have 
few opportunities of observing, as for the most part 
the discharge even of a small quantity would in such 



SeC. IV. OF LUES VENEREA. 191 

circumstance prove hurtful, and therefore is not advi- 
sed : We have reason, however, to conclude, that it 
is the reverse of what takes place from inflammation, 
as the most effectual remedies we employ here, are a 
generous diet, wine, and bark. 

This opinion of the effects of mercury upon the 
system receives some confirmation, I may remark, 
from the putrescency which it evidently excites in the 
mouth; and from the peculiar tendency both of mer- 
cury and scurvy to excite a tender st te of the gums, 
and a very foetid state of the breath, we. have reason 
to suppose that the effects of both are in some degree 
the same. 

This might be farther elucidated by various argu- 
ments which the extent of this publication will not ad- 
mit. Enough, however, has been said for the purpose 
of explaining the chief part of the treatment I have ven- 
tuied to propose ; particularly that which relates to di- 
et and other articles o( regimen during a course of 
mercury. 

In speaking of scrophula as an impediment to the 
action of mercury in the cure of Lues Venerea I do 
not mean to say that the disease cannot be cured in 
scrophulous constitutions. We daily meet with the 
contrary of this : But we also find, when the same 
sore partakes both of scrophula and Lues Venerea, 
that we do not derive the same advantages from mer- 
cury as in sores purely venereal. In such circumstan- 
ces, after as much mercury has been given as is pro- 
ductive of any beneficial effect, and of which we judge 
by the sores or other symptoms making no progress 
towards farther amendment, our best chance of effecting 
a cure is to omit the mercury, and not have recourse to 
it again till by the use of bark, cold bathing, cicuta, 
and other remedies employed for scrophula, the dis- 
position is corrected or removed by which the opera- 
tion of the mercury upon the syphilitic symptoms was 
rendered ineffectual. 

But the most frequent cause of our failure w 7 ith 
mncury in the cure of this disease is that which I have 
already had occasion to insist upon, our giving it in 



192 OF THE REMEDIES USED Cll. IV. 

such small quantities as are not sufficient in the more 
advanced stages of the disease for eradicating the virus ; 
by which, although the symptoms may all be render- 
ed much milder, or even apparently removed, they 
either do not entirely disappear, or if they do, are af- 
terwards very apt to recur. This, however, is not the 
fault of the remedy, but of the method of giving it, 
and of which all who adopt the practice of giving it 
in sufficient quantities will be convinced, Since I 
went into this practice, besides having had many in- 
stances of the medicine proving effectual when exhi- 
bited in these quantities, where it had previously fail- 
ed, T have not as yet, and several years have elapsed, 
bad a single instance of its failure, except in such 
combinations as I have mentioned, or where the con- 
stitution was in such a state of debility that a sufficient 
quantity of mercury could not be employed. But 
even of these very few cases have occurred. I have 
no hesitation, therefore, in saying that mercury un- 
der proper management may, with very few limita- 
tions, be considered as a certain remedy for syphilis, 



We are not acquainted with any cases in which the use of Mer- 
cury (as formerly prescribed,) has not been amply sufficient to erad- 
icate the venereal poison, except those which the author has no- 
ticed ; and we are inclined to say with him that under judicious 
management, mercury seldom or ever fails, in the cure of Lues 
Venerea. Ed. 

6 3. Of Guiacum 

Guiacum has long been employed as a remedy in 
Lues Venerea. It was used indeed very generally 
over Europe soon after this disease came to attract the 
attention of practitioners. Being for some time the 
only remedy upon which any dependence could be 
placed, it was at first greatly extolled by all who wrote 
upon it ; and from the testimony given of it by authors 
of the first reputation, not only of these times, but of 
later periods, there was no reason to doubt of its be- 
ing possessed of the power of mitigating, and perhaps 



See. if; IN LUES VENEREA; 193* 

of curing some of the symptoms of syphili3. The 
powers of mercury, however, were found to be so pre- 
eminent that guiacum came at last to be seldom used 
by itself, but by many it was, and still is continued 
as an assistant to mercury. 

Being seldom given bv itself many came at last to 
doubt whether any advantage was obtained from it 
or not i and some went so far as to say that it posses- 
sed no power whatever over any symptom of this dis- 
ease. This is one, which among other effects, might 
be mentioned that result from habit and prejudice, t 
own too, that from the same cause I was at one period 
of this opinion, till I found by experiment that guiac- 
um in different forms could even bv itself remove ma- 
ny of the symptoms of syphilis. Venereal ulcers and 
blotches upon the skin are the symptoms in the remo- 
val of which its effects are most conspicuous. In 
three cases of ulcers, and one of blotches upon the 
breast and arms, all clearl\ marked, and in which mer 
cury had never been employed, the symptoms were- 
completely removed by the internal use of guiacum 
alone. In the patient with blotches, however, the dis- 
ease returned in the space of a month, but not in the 
same form. In one of the others the ulcers appeared 
again at the end of six weeks. In a third they con- 
tinued well after three months had elapsed, but what 
became of this patient afterwards, and of the fourth, I 
do not know 7 . The two first were afterwards cured 
with mercury. 

Although the result of these trials did not induce 
me ever to trust to guiacum alone, they gave suffi- 
cient ground to consider it as a remedy from which, 
some advantage may be occasionally derived when 
conjoined with mercury ; accordingly I have been led 
to continue, or rather to recommence the use of this 
remedy in many cases of syphilis, for at one period, 
from the cause I have mentioned, I had laid it entire 
]y aside. 

I believe, indeed, that I would have been induced 
to place more dependence upon it, or at least to have 
prosecuted my experiments with regard to it farther 

vol, m 25 



194 OF THE REMEDIES USED Gil. IV. 

than what I had done, if I had not been prevented by 
the result of some trials which Mr. Hunter also had 
made with it, and which he published about the same 
period. By these it evidently appeared that guiaeum 
has a considerable influence upon the venereal virus. 
I never made trial of it as a local application ; but 
Mr. Hunter found that in this manner it cured venere- 
al ulcers, first in one part of the body, and afterwards 
in others, where sarsaparilla employed in a similar 
manner had failed. He found too that very numerous 
venereal ulcers were removed by the internal use of 
it, but after both trials the disease soon returned. Mr. 
Hunter's experiments were made with the gum, mine 
with an extract and strong decoction of the wood. 
The extract seemed to be equally effectual with the 
decoction, but as it has a strong tendency to affect the 
bowels I soon left it off. and employed the latter only. 
In these cases to which I allude, as well as in some 
others, a very strong decoction was employed, three 
ounces of the wood to an English quart of water, that 
is, this quantity w 7 as boiled in two quarts of water into 
one, and this was taken in the course of a day, either 
by itself or mixed with milk; but as it is apt to purge 
when of this strength, and is likewise disagreeably 
acrid, and as I never now depend upon it alone for the 
cure, I seldom put more than an ounce to this quanti- 
ty of decoction.^ 

That mercury might not cure every symptom of sy- 
philis equally well whether guiaeum was employed 
along with it or not I will not positively say ; but I 
am disposed to think, and not without much attention 
\q the subject, that the cure commonly goes on more 
easily when the two are conjoined than when mercury 
is given to any great extent by itself. I am therefore 
in the frequent habit of using guiaeum, particularly 
where the disease is of long duration and has appeared 
upon the surface, either in the form of ulcers or erup- 
tion. It has also been much recommended for its effi- 
cacy in nodes, and for the removal of those pains re- 

* Vide Appendix, No. 22 



Sec. IV. IN LUES VENEREA. 195 

sembling rheumatism, which frequently proceed from 
syphilis. 1 have not found, however, that it proves so 
useful in nodes as in other symptoms of the disease; 
and where pains only take place we ci.n never with 
such certainty determine from what cause they pro- 
ceed, as they are undoubtedly one of the most equiv- 
ocal symptoms of syphilis, and there is no cause to 
doubt of guiacum being a very useful remedy incases 
merely rheumatic. 

I have in different instances found a strong decoction 
of £uiacum prove particularly useful in the cure of 
those extensive ulcers which sometimes succeed to bu- 
boes. In some the guiacum answers by itself, but it 
proves more frequently successful, as we shall here- 
after have occasion to mention, when conjoined with 
mezereon and sarsaparilla. 



The Lignum Guaiaci or Guiacum Wood was first employed by 
the natives of St. Domingo as an antidote against the Lues Vene- 
rea ; the Spaniards soon acquired a knowledge of its virtues, and 
introduced it into Spain in the year 1508, and in a short space 01 time 
it acquired great celebrity Its reputation as an an ti- venereal con- 
tinued high for two centuries, although repeated instances occurred, 
in which it was given in vain. Mr. Pearson observes that when he 
was first entrusted with the care of the Lock Hospital in 178', it 
was a favourite remedy with his colleagues. The patients for whom 
the guiacum was directed were those who had previously used the 
usual quantity of mercury, but who complained of nocturnal pains, 
who had gummata, nodes, ozccna, and such other effects of the ve- 
nereal virus, connected with secondary symptoms, as did not yield 
to a course of mercurial frictions. The diet of these patients con- 
sisted of raisins and hard biscuit; they drank from two to four pints 
of the guiacum every day, they were ordered to use the hot bath 
twice in the week ; and they commonly took a dose of antimo. iai 
Wine and Laudanum, or of Dover's powder, every evening. Con- 
stant confinement to bed was not deemed necessary ; and they were 
seldom exposed to the vapour of burning spirit to excite perspira- 
tion, as only a moist state of the skin was required. This treat- 
ment was sometimes of singular advantage to those whose health 
had sustained injury from the complicated operation of the disease, 
combined with confinement and a long course of mercury. The 
strength increased, untractable ulcers were frequently healed, cari- 
ous bones exoliated, and those anomalous symptoms which would 
have been exasperated by mercury, yielded readily to the decoction 
of Guiacum. Mr. Pearson observes that this Medicine was also 



196 OF THE REMEDIES USED Ch. IV. 

formerly given on the first attack of the venereal disease, and from 
the benefit derived, a radical cure was considered to be accomplish- 
ed. Frequent relapses however followed, and Mr. Pearson re- 
marks that although it may operate like a true antidote, in sus- 
pending for a time, the progress of certain venereal symptoms and 
removing other'appearances altogether, yet experience has evinced 
that the unsubdued virus yet remains active in the constitution. 

In exhibiting the decoction of Quiacum for pains in the bones, 
Mr. Pearson rarely found any benefit, except where it acted as a 
sudorific, and in this respect he considers it inferior to antimony or 
volatile alkali. When the constitution has been impaired by a suc- 
cessful course of mercury and long confinement, and a thickened 
state of the ligaments, or periosteum, or foul ulcers still remain, 
these sores will heal and the enlarged membranes subside, during 
the administration of the decoction. It will also suspend for a time, 
the progress of certain secondary venereal symptoms^ such as, ul- 
cers of the tonsils, venereal eruptions, and even nodes, but Mr. 
Pearson never saw an instance, in which the venereal virus was erad- 
icated by the powers of this medicine, nor does he consider a com- 
bination of it with mercury, as increasing the virtues of the mine- 
ral, nor lessening the necessity of giving a certain quantity of it., 
He has however administered the guiacum with good effect in Cu- 
taneous Diseases, and in the ozoena. (Pearson on the effects of va- 
rious articles in the cure of Lues Venerea.) 

Ed. 

& 4. Of Sarsaparilla, 

Sarsaparilla has been long employed in (be cure of 
Lues Venerea, and from the result of some trials 
which I made wilh it I am disposed to think that some 
advantage may be derived from it. The trials which 
I have made with it along with mercury have been nu- 
merous, but it is not upon these that any judgment can 
he formed of its real efficacy. Neither have I given 
it often where mercury had not been previously used ; 
but I have had many opportunities of using it in cases 
where mercury had not proved altogether successful, 
whether from being given in too small quantities, or 
from being exhibited without that attention to regimen 
which it requires, and in a great proportion of these 
it has been productive of evident good effects. I have 
found it particularly useful in those symptoms which 
chiefly affect the skin, such as blotches and the remains 
of old venereal ulcers. When mercury from either of 
the causes which I have mentioned has failed of com^t 



beC. IV, M LUES VENEREA. 197 

pleting the cure, I have in various instances known it 
accomplished by sarsaparilla, where otherwise there 
was much reason to think that mercury in a larger 
quantity, or given in a different manner, would have 
been necessary. 

I have given sarsaparilla in powder, in extract, and 
in decoction, but the latter has always appeared to an- 
swer best. Not unfrequently I conjoin it with guia- 
cum, and it answers the purpose of blunting the acri- 
mony of the latter.^ 

Sarsaparilla and guiacum have both a tendency to 
promote perspiration. Besides any power which they 
may possess of acting directly upon the venereal vi- 
rus, they seem also to prove serviceable where mercu- 
ry goes too readily to the mouth, in diverting it from 
that outlet* 

* Vide Appendix, No. 23. 



The Radix Sarsaparilla "was introduced into Europe from the 
West Indies as a remedy of great efficacy in venereal cases, about 
the year 1530, but afterwards lost its fame. It was again brought 
into notice by the late Dr. William Hunter, who advised Dr. Chap= 
man to use it in a bad case of phagedenic bubo, and from the bene-* 
fit derived, Dr. Hunter was induced to recommend it to other prac- 
titioners. Sir William Fordyce in a memoir contained in the " Med- 
ical Observations and Inquiries, vol. 1st." speaks highly of its vir- 
tues and considers it effectual in curing many of the secondary symp- 
toms, without the aid of mercury. He also observes that in chan- 
cres it will be of little service, but thinks it probable that sarsaparil- 
la will always cure what resists the powers of mercury. Mr. Pear- 
son in opposition to the above writer, contends that this medicine 
has not the power of curing any one form of the disease, and cites 
in favour of this opinion the observations of Cuilen and Brornricld. 
He allows however, that it may suspend for a time the ravages of 
the disease, — that it will alleviate symptoms, derived from the joint 
action of mercury and the venereal poison on certain constitutions? 
or such as are often the sequelee of a full course of mercury, such 
as nocturnal pains, membranous nodes, cutaneous ulcerations, &.c. ; 
but adds that the combined exhibition of sarsaparilla with mercury 
does in no case diminish the necessity of giving a certain quantity 
of the latter. (Pearson on the effects of certain articles in the cure 
of Lues Venerea, 1st Edit. 1800.) 

Sarsaparilla is an important ingredient in several French prescrip- 
tions of high reputation. The AntUstjfihilitic Rob of Laffacteurh 



198 OF THE REMEDIES USED Cb. IV 

one of these, and we are indebted to Dr. M'Nevin for the following 
receipt for preparing it. 

Take of Sarsaparilla 5xxx. 

Marsh reed grass, (Arundo phragmatis) 5xxx. 
Flowers of Borage, 5viij. 
Senna and Roses, aa ?ij. 

Boil these for one hour in nine pounds of water, then strain the 
liquor ; put an equal quantity of water on the residuum, and boil it 
again for nearly two hours, strain this, and to both decoctions, add 
six pounds of sugar, as many of honey, and boil down the whole to 
the consistence of a rob. The dose for men is six table spoonfulis, 
and for women, four. For further directions, we refer the reader to 
Dr. M'Nevin's Paper on this subject. He observes that the effica- 
cy of this medicine is confined to those venereal cases which have 
been aggravated by the abuse of mercury, and that it is seldom ser- 
viceable in the primary stages. Another Medicine much in use in 
the French Hospitals is the Syrup, of Cusinier f which is prepared as 
follows : 

Take of Sarsaparilla Jj^x. 
Senna, 5x. 

Flo\rers of Borage, 5iij. 
Flower of Roses, 5nj. 
Boil and strain and add sugar and honey each forty pounds, and reduce the 
whole to the consistence of a syrup. 

Dr. M'Nevin adds that he has found a saturated decoction of sar- 
saparilla and guiacum answer as well as either of the above, taking 
care at the same time, to confine the patient to a warm room, and to 
prevent costiveness. (New-York Med. and Phil. Journal and Re- 
view, Vol. 3d. P. 23.) E». 

$ 5. Of Mezereon. 

The root of this plant has long been employed for 
the removal of schirrous tumours by whatever cause 
they may be produced, and many have thought that it 
lias proved particularly useful in venereal nodes, as 
well as in some other symptoms of this disease. As I 
have not made much use of it where mercury was not 
either employed along with it or before it was given, 
J cannot from my own observation determine whether 
It is possessed of the power of curing syphilis by it- 
self or not ; but from much experience of the effects 
of it when conjoined with mercury, I can say deci- 
sively that in this manner it often proves useful. I 



SeC. IV. IN LUES VENEREA. 199 

have never known any advantage that was sufficiently 
clear and obvious derived from it in nodes, but it cer- 
tainly tends to heal those ulcers which sometimes re- 
main obstinate after the quantity of mercury is given 
that we judge to be necessary. 

I have already had occasion to mention that spread- 
ing ulcers of this kind are particularly apt to succeed 
to buboes, and that they often resist all the remedies 
that we employ for them. As this sometimes happens 
after a very full quantity of mercury has been given, 
and as the sores often heal at last from the effects of a 
change of regimen alone, I conclude that they are not 
kept up by any remains of Lues Venerea ; and as it is 
in this state of the disease that I have chiefly observed 
any advantage to accrue from mezereon, I conclude 
that it acts particularly by correcting that state of the 
system which long continued use of mercury is apt to 
induce, and which by experience we find to be very 
inimical to the cure of all such sores as the patient at 
the time may labour under. 

It seems to be in this manner that Kennedy's decoc- 
tion, and of which mezereon appears to form a consid- 
erable part, proves particularly useful. There is no 
reason to suppose that any quantity of mercury is con- 
tained in that decoction, and yet there is no cause to 
doubt of sores of this description having been often 
soon healed by it, which had previously resisted every 
aitempt that was made to cure them. Of this 1 could 
mention several histories which have fallen within my 
own knowledge, but they are too long to admit of in- 
sertion in this place. This decoction, I may remark, 
appears to be nearly, or perhaps entirely the same 
with the Lisbon decoction, for which a form is given 
in the Appendix.* 

In using this root it is proper to observe, that the 
ligneous parts of it are altogether inert. The bark of 
the root appears to be the only active part of it. An 
English quart, containing a drachm and a half of the 
bark, is a sufficient quantity to be taken in the course 

* Vide Vol. I. Nos. 46 and 47. 



200 OP THE REMEDIES USED Cfr.lV,. 

of a day, and even this, when the root is in perfection 
renders the decoction so acrid that it is apt to affect 
the throat. With a view to lessen this acrimony we 
conjoin it with gum arabic, liquorice, althea, and of- 
ten with sarsaparilla.^ 

* Vide Vol. II. No. 24. 



The Mezereon Root was recommended by Dr. Alexander Ru'ssel 
in the " Medical Observations and Inquiries, vol. 3," as a cure for 
the venereal node, but he added that it was not found of service in 
ihe removal of any other symptoms. Mr. Pearson however asserts 
that it has not the power of curing the venereal disease, in any one 
stage, or under any one form, and considers its use unnecessary, 
since the good effects attributed to it are derived, without its dis- 
agreeable qualities, from the Guiacum, Sarsaparilla, 8cc. (Pearson.) 

As the Lisbon Diet Drink and the Decoction of the Woods are 
famous prescriptions in venereal cases, we give the following for- 
mulas in additition to those contained in our author's appendix 
When the disease is doubtful, or mercury disagrees, or has been 
given in sufficient quantity, such remedies may often be administer- 
ed with great benefit. 

R. Sarsaparilla concisae. 

Ligni santali rubri. 

Ligni santali citi-on. sing : ?iss>. 

Radicis Glycyrrhezse. 

Radicis mezerei sing : Zij, 

Ligni rhodii. 

Ligni guiaci officinalis. 

Ligni sassafras sing : ^iss. 

Antimonii ?i. 

Aquae distillate ffo v. 
These Ingredients are to be macerated for twenty-four hours, and aftcrvvaic ^ 
boiled till the fluid is reduced to half its original quantity. From one to four 
pints are given daily. 

The following decoction is said to be the genuine Lisbon Die- 
Drink. 

R. Sarsaparillee concisx. 

Radicis Chinse sing : 5i. 

Nucurn juglandis cortice siccp.ivr^m No "* 

Antimonii 5j. 

., . ■. . *Ji . - . . — . 

Lapidis pumicis pulvensati ^; 

Aquse distillate jfex. 

The Powdered Antimony and Pumice Stone are to be tied in sep- 
<?rate pieec* of ras? and boiled along with the ether ingredients,— - 



HeC. IV. IN LUES VENEREA. 201 

(Rees' Cyclopedia, Art. Lues Venerea.) Mr. Pearson appears to 
incline to the opinion that antimony is the important ingredient in 
the above preparations, in promoting a determination to the skin, 
The Decoctum Sarsa/mrilla comfiositum of the London and Dublin 
Pharmacopeias will also be found an useful remedy. Er>. 

§ 6. Of Opium. 

Opium bad long been employed for Ibe relief of 
that kind of irritation which some of the symptoms 
of Lues Venerea are apt to excite, but it was not till 
within these fourteen years that it was supposed to 
possess any power of destroying the venereal virus, 
or of curing this disease. It was first employed with 
this view in the British hospitals in America ; and 
Doctor Michaelis, physician to the Hessian troops 
was, I believe, the first who put it to the test of ex- 
periment. 

Since that period it has been used as an antisypmlitie 
medicine by various practitioners in almost every part 
of Europe ; and it has had the fate of almost every 
new remedy, or of every remedy employed with new 
motives. Some have spoken of it in the highest terms 
of panegyric, while others do not admit that it is ca- 
pable o( removing even the mildest symptom of the 
disease. In matters of doubt all that authors ought 
to attempt is to state clearly what they know to be 
matter of fact, as it is from the result of repeated tri- 
als properly authenticated that an adequate judgment 
on all such points is alone to be formed. As it ap- 
peared to be a matter of the first importance to have a 
new remedy for the cure of Lues Venerea, and which 
was reported to act with much more ease and certainty 
than mercury, I was one among many who gave it a 
very full trial. It was used in a variety of cases and 
in different stages of the disease; but in no instance 
did it accomplish a cure where there was cause to sup- 
pose that the virus was not previously destroyed by 
mercury. Sores originally produced by this virus, 
and kept up, as is sometimes the case, by irritation 
alone, and long after the venereal taint is d 

vol. ii. 20 cstroved. 



202 OF THE REMEDIES USED Cll. 



l\ 



are more effectually cured by opium than any oilier 
remedy. Sores which from this cause have remained 
obstinate for a great length of time, are, by the use of 
opium, often brought to a healing state ; and when the 
constitution is not otherwise diseased, they are, for the 
most part, soon cicatrised. It is proper, however, to 
distinguish between these sores and such as are vene- 
rea L Sores in this state are not to be considered as 
venereal. The venereal virus, it is true, has acted a,s 
the exciting cause, but tills being destroyed by mer- 
cury, they no longer depend upon this, and in such 
circumstances are to be treated in the same manner 
with sores of a similar nature proceeding from any 
other cause. In whatever way sores may have taken 
place, if much irritation prevails, opium is perhaps 
the best remedy we can employ, but I have not found 
that it proves more effectual in sores that are the con- 
sequences of Lues Venerea than in such as are produ- 
ced by any other cause, provided the degree of pain 
and irritation with which they are accompanied be the 
same. 

I suspect much, therefore, that this distinction has 
not met with sufficient attention by many who consider 
opium as a remedy in the cure of syphilis. By acting 
as a very effectual remedy in the cure of many sores in 
which mercury had failed, they have been induced to 
attribute powers to opium, which I have much reason 
to think it does not possess, for I have never known it 
prove effectual where mercury had not previously 
been given. 

Antisyphilitic powers being once attributed to opi- 
um it was readily imagined that in proportion to the 
quantity exhibited it would prove more or less effect u- 
al. It was accordingly given in large doses, and these 
were more frequently repeated than had been usual in 
former, practice. Few, I believe, made more com- 
plete trials of it, or have pushed it farther than I have 
in various instances done : Beginning with two grains 
at bed-time, one in the morning, and another at mid- 
day, and adding a grain to eacii dose every third or 
fourth day, patients in this manner I have found could 



S€C. IV. IN LUES VENEREA. 203 

bear very considerable quantities in the course of a 
short time. One of my patients who could not at first 
bear more than a grain at once, in the course of five 
weeks look three doses of fifteen- grains each, daily. 
I did not find, however, that any advantage was deriv- 
ed from giving it so largely, while it frequently did 
much barm. It was apt to excite sickness, head-ach, 
and giddiness, a total loss of appetite, in some an ob- 
stinate costiveness, and what was more surprising, it 
acted with many as a smart purgative. I never observ- 
ed this effect, however, till the dose came to the ex- 
tent of ten or twelve grains; but when this symptom 
did take place from it, no astringent medicine seemed 
to have any effect in removing it, and ii was only re- 
lieved by emetics and purgatives. 

I must indeed admit that opium was taken by many, 
even in large doses, without any inconvenience or dis- 
tress ; but being soon sensible that it had no effect in 
destroying the venereal virus; that it proved in no 
other way useful than by lessening or removing irrita- 
tion ; and that this resulted with equal certainty from 
moderate doses, I have of late desisted from giving it in 
larger quantities than two or three grains in the course 
of a day. 

Opium conjoined with an emetic has long been 
known as a very useful remedy in rheumatism; and I 
have found it prove particularly useful in those pains 
resembling rheumatism which occur in the venereal 
disease. But the relief which it procures is only tem- 
porary- if mercury be not employed along with it. 
For this purpose laudanum may be given along with 
tincture of antimony, or opium may be given with 
ipecacuan, in the form of Dover's powder!* 

Jn some cases opium proves useful as an external 
application, whether employed as a wash for painful 
phagedenic ulcers, or in a solid form as an ointment ; 
but it does not appear, even in this manner, to act in 
any other way than as an anodyne, 

Vide Appendix, No, "31 



204 OF THE REMEDIES USED CI]. IV. 



Opium was first employed as a specific in the {Military Hospitals 
in the City of New-York, about the year 1779. In the opinion 
given by our author on its anti-syphilitic virtues, he is seconded by 
the unanimous voice of the profession. The utility of opium is 
confined to its preventing that irritable state of the bowels, or sys- 
tem, which mercury sometimes induces, and thus enabling the prac- 
titioner to administer the latter in sufficient quantity. 

Besides the articles enumerated in the preceding sections, as re- 
medies in the cure of Lues Venerea, we shall mention a few addi- 
tional ones, some indeed of no great reputation, while others are of 
considerable utility. 

The Cinchona or Peruvian Dark is considered by Mr. Pearson as 
a salutary medicine in several of the symptoms of lues venerea.— j 
He has observed incipient buboes reduced, although not cured by it ; 
venereal ulcers in the throat become clean and heal, although the 
disease recurred ; and a gangrenous appearance of chancres, togeth- 
er with a consequent mortification of the penis, occurring in pecu- 
liar constitutions, totally removed by its exhibition. There are ca- 
ses however he remarks, in which after the slough has separated 
and the ulcer assumed a clean and favourable aspect, it will become 
painful and foul and spread with thick and indurated edges. At this 
crisis, the bark is to be abandoned and mercury is to be exhibited. 
Mr. Pearson concludes by observing that where the tonic powers of 
the bark are not indispensably necessary, it ought not to be given, 
since the power it possesses of diminishing the several secretions 
may prove detrimental. 

Several other vegetable remedies have acquired a short lived re- 
putation. Among these are the Radix China whose consequence 
originated in the report of its having cured the Emperor Charles 
V.; the Cicuta, recommended by Dr. Storck, and useful in prevent- 
ing the spreading of irritable sores, whether connected with the 
venereal virus, or remaining after a mercurial course ; the Sassa- 
fras Junifierus, Lobelia syphilitica, Safionaria Dulcamara, Astra- 
galus Exscafius, and the green rind of the Walnut, which Mr. 
Pearson has used for many«years with advantage in cases where pains 
in the limbs and indurations of the membranes have remained after 
a full mercurial course. 

The Ammonia /irc/iarata, or Volatile Alkali, which was first in- 
troduced into notice as an Anti-Venereal by M. Peyrilhe, was found 
beneficial like other diaphoretic medicines in pains of the limbs and 
in venereal eruptions, and Mr. Pearson has also found the Muriate 
of Barytes, of which Mr. Bell speaks hereafter, (Chap. IV. SecL 
IV. § 2.) useful in painful and ill-conditioned sores derived from a 
venereal cause, and it has proved beneficial by improving the health 
in general. This medicine, along with the Muriatic and Vitriolic 
Acids appear from Mr. Pearson's experiments^ to have the power 
of suspending for a limited time, the progress of the disease, and 
are useful in phagedenic ulcers of the genitals, of the penis, andcf 



Sec. IV. IN LUES VENEREA. 205 

the threat. The tonic power cf the acids will also be found advan- 
tageous. The remedies however which of late years have raised 
the highest expectations among practitioners, and have excited the 
sanguine hopes, as well as the deliberate examination of many, are 
the JVitric Acid and the Oxy -muriate of Gold. Valuable as these 
medicines are in several of the symptoms of Lues Venerea, the re- 
sult of the investigations concerning them has only added new proof 
for the opinion that mercury is the only specific. 

Of the Nitric and Nitrous Acids. The Nitrous Acid was first 
introduced into notice as a remedy for the Lues Venerea by Mr. 
Scott, Surgeon at Bombay, in April, 1796. On transmitting an ac- 
count of his success to England, it was immediately used by a num- 
ber of practitioners, several of whom have given the result of their 
experience to the public. Among these may be named Dr. Beddoes, 
Dr. Rollo, Dr. Ferriar, Mr. Pearson and Mr. Blair. Mr. Scott is 
said to have caught the idea from Dr. Girtanner, who suggested 
that the efficacy of the various preparations of quicksilver might 
arise from th'e oxygen which they contained. The success which 
he appears to have met with, in India, does not correspond with the 
result of Mr. Pearson's and Mr. Blair's experience in England 
The former gentleman found both the nitric and nitrous acid, com* 
pletely able to remove the primary and secondary symptoms in sev- 
eral cases, whilst in a vast majority, they were nevertheless, inade- 
quate. He observes however that where the constitution is so im- 
paired, as to render the introduction of mercury improper, the ni- 
trous acid will restrain the progress of the disease, and also im- 
prove the patient's health. Another advantage which Mr. Pearson 
has remarked is when given in conjunction with a course of mer- 
curial unction, it improves the appetite, determines powerfully to 
the kidnies, and counteracts in a considerable degree the action of 
mercury on the mouth and fauces. (Pearson, 1st Edit.) Di\ Fer- 
riar found the nitric acid useful in removing pains in the bones and 
also in ulcers remaining after a mercurial course, but does not con- 
sider a less quantity of mercury necessary to remove the disease, 
even when given in conjunction with it. (Ferriar's Med : Histories 
and Reflections, 1810. vol. 3rd.) In further experiments on this 
subject, the nitric acid ought to be used instead of the nitrous. It 
is given in the following manner. Mix 51 of the nitric acid with a 
pint of distilled water and sweeten the mixture with simple syrup. 
This quantity is to be drank at different times, in the course of 
twenty -four hours, through a small glass tube, which is used to pre- 
vent the teeth from being injured. If no inconvenience is felt, the 
dose may be increased to 5"ij or even 5 u j- It will be found most ad- 
vantageous in the primary symptoms. 

The Oxygenated Muriate of Potash, which contains an immense 
quantity of oxygen, is stated by Mr. Cruikshank, to be more effi- 
cacious than the nitric acid, in relieving venereal symptoms. Dr. 
Ferriar observes that he has perceived no remarkable advantage 
from its use. 

In an able article in Rees' Cyclopedia on Lues Venerea, it is sta- 
ted on the authority of Richerandjthat experiments have been .made 



206 OF THE REMEDIES USED Ch. IV. 

at the Ecole de Medicine at Paris, with the oxygenated fat and ni- 
tric lemonade. The former is probably the Oxygenated Cerate of 
Mr. Alyon, which Mr. Pearson mentions (a composition of nitrous 
acid and hog's lard) and which he found useless. Mr. Richerand 
mentions that a few cures were effected by the above remedies, that 
some received temporary relief, whilst others suffered such relap- 
ses as to render a resort to mercury necessary. 



o Gold. 

In addition to the remedies already noticed in the 
cure of Lues Venerea, we may notice different 
preparations of Gold, some of which were at an 
early period prescribed in its treatment, and as 
speedily abandoned. Its use has however, of late 
been revived, both on the continent of Europe, 
in Great Britain, and subsequently in this country, and 
has been attended with various success. By some it 
is considered as a specific, by others as inert, while a 
third considers it injurious, producing troublesome ef- 
fects on the stomach and chylopoetic viscera. We 
confess on the first trials we made with this medicine 
(the triple muriate of gold and soda) we were incli- 
ned to regard it not only as a specific, but one which 
we fondly hoped would supersede, the more trouble- 
some and painful one then in use ; but experience 
soon taught us that this hope was delusive ; for though 
chancres and buboes, rapidly healed and disappeared 
under the use of it, and the disease appeared to be 
totally eradicated; yet in every case where we 
trusted to it alone, the patient returned in the course 
of a few weeks with ulcers in the throat; these how- 
ever easily yielded to a slight alterative course of 
mercury. From these cases we were led to the con- 
clusion, that though no confidence could be placed in 
it as a specific, it was nevertheless a most important 
auxiliary in the cure of Lues; and we have used it 
in all cases of chancre or bubo which have come un- 
der our care, for upwards of two years, and with the 
happiest effects. We commence with the gold and 
continue it till the chancre or bubo disappears ; when 
we immediately begin with a moderate alterative 



Sec. IV. IN LUES VENEREA, 207 

course of mercury, which is continued for five, six or 
more weeks, making use at the same time of the De- 
coction of the Woods. This is a much less painful 
course for the patient, and infinitely less troublesome 
to the physician, than when mercury alone is given, 
and has proved equally effectual in every case in 
which we have given it, — so perfectly so, that in up- 
wards of two years we have not seen or heard of a 
single case of its failure. In secondary affections, we 
have not experienced the same good effects from this 
remedy ; though we have tried it in several cases, 
where the patient could not conveniently hear the ac- 
tion of mercury. We have given it to the extent of 
a grain in the twenty-four hours, in the form of Pills, 
The following is our ordinary prescription, viz. 

E. Miiriat : Aur : et Sod : Gr. i. 
. Pulv : Glycyrrhiz : Grs. x. 

Hue .lag- : G. Arab : q. s. M. ft. Mass : et 
divid : in pill : No. xij. 

Three of these pills to be taken, three or four times 
a day, and the chancres to be dressed with dry lint. 

The only sensible effects that we have observed 
the gold produce, are exeited on the kidneys, the 
quantity of urine being greatly increased; at least 
we have known but one exception to it: indeed so pow- 
erfully diuretic did it prove, that we were induced 
to give it a trial in a well marked case of Ascites, in 
which it was attended with more than the expected 
success. 

We have not in a single instance discovered any 
bad effects of the gold either on the stomach or any 
other organ. 

For some account of Gold as a remedy in Lues 
Venerea, 

Fide Medical Repository Vol. XIV. page 197. 

Eclectic Repertory Vol. III. page 281. 289. 
New-England Journal, Vol. I". page 171. 
Vol. II. page 5, 

Ed 



208 OF THE CUR* Ch. IV, 

SECT. V. 

Of the Cure of Lues Venerea. 
$ 1. Of the Cure of Chancres. 

A DESCRIPTION of chancre is given in Section 
II. of ibis chapter, page 12. The first question to be 
determined in the treatment of chancre is, whether 
the cure should be trusted entirely to the internal ex- 
hibition of mercury ; to the use of local applications ; 
or to both of these combined. 

A considerable time ago I had occasion to mention 
my opinion on this subject, and hitherto I have seen 
no good cause for deserting it.* My opinion at that 
time was, as it still is, that chancres should be healed 
as speedily as possible, and that this may be done with 
safety by combining the advantages of local remedies 
with the internal use of mercury : 

Many practitioners think that chancres ought not to 
be healed but by the internal use of mercury alone, 
and they give as reasons for this, that when externa! 
applications are employed we can never be certain 
whether the constitution is rendered safe or not, while 
we can scarcely be deceived, they imagine, when 
chancres heal solely from the use of mercury. To 
this practice, however, there are different objections. 
The internal exhibition of mercury alone will not al 
ways cure chancres. I have known a person kept un- 
der the complete effect of mercury for many weeks. 
and the chancres for which it was prescribed remain 
nearly in the same state as at first. Nay, in differ- 
ent instances, where this practice was pursued, and in 
which ihe cure was trusted to mercury alone, although 
the remedy was continued in all of them for six or 
seven weeks, and under the best management, as the 
chancres did not heal the mercury was laid aside on 
the supposition of the constitution being rendered 

* Yide Treatise on the Theory ?nd JNlanagemcnt cf T : - 



SeC. V. OF LUES VENEREA . 209 

safe; but although in all of them the sores were soon 
cured by the application of caustic, red precipitate, 
or some other escharotic, in several, symptoms of pox 
appeared in the course of a few weeks ; in some with 
ulcers in the throat, and in others with blotches upon 
the skin. From which I conclude that we cannot de- 
pend upon the internal use of mereuy alone for the 
cure of chancres ; nor have I observed that it acts 
with certainty, unless the sores are kept up by the vi- 
rus having entered the constitution. 

But the most important objection to the practice is, 
that being much more tedious in accomplishing a cure, 
it creates a greater risk of the virus entering the sys- 
tem than when the sores are more speedily healed by 
the use of external applications. The practice of heal- 
ing chancres by the internal use of mercury only, ori- 
ginated from an opinion that venereal sores of every 
description proceeded from the constitution being in- 
fected, and were this the case, there might be cause to 
consider it as well founded; but now that we know 
that chancres at first are always local, and that they 
are the source of whatever matter enters the system, 
it is obvious that the more speedily they can with pro- 
priety be healed, the less will be the risk of the consti- 
tution being injured. 

Chancres might frequently be cured by the use of 
external applications alone, and as we know from ex- 
perience that the matter is not always absorbed, the 
cure would in a few instances prove permanent ; but 
as we have no means of distinguishing when this is the 
case, while there is reason to think that in most instan- 
ces absorption takes place, we ought in no case to 
trust to it. In order to avoid the inconveniences of a 
course of mercury, it has been fashionable of late to 
trust the cure of recent chancres to local remedies, but 
I know from various instances in which I have been 
consulted, that the practice is exceedingly dangerous. 
The chancres may be easily healed ; but where mercu- 
ry is not employed the disease in a great proportion 
of cases soon shews itself in the system. 

The most certain, as well as the speediest cure of 

vol. ii. 27 



'210 OF THE CUKt; Ch. IV. 

chancres is to be obtained from a clue attention to ex- 
ternal applications conjoined with a well regulated 
course of mercury. By -the former we are frequently 
enabled to complete the cure in a few days, which 
otherwise would require a great length of time, and 
by the latter the constitution is rendered perfectly se- 
cure. 

Chancres in an incipient state are most effectually 
cured by the application of caustic or eseharotics. 
If the diseased parts are completely destroyed with 
caustic they soon become clean, and heal as quickly 
as sores proceeding from any other cause and of the 
same magnitude usually do. This practice is now very- 
general ly adopted, and the effect of it is so remarka- 
ble that it has never probably bren laid aside by any 
who have given it a fair trial. Kone, I imagine, have 
pursued it more fully than I have done; but I find it 
necessary to remark, that in the usual way of con- 
ducting this practice it is liable to one very important 
objection : the chancres to which it is applied, if they 
are not of long duration, very commonly heal quick- 
ly ; but in a great proportion of cases the cure of the 
sores is succeeded by buboes in the contiguous glands. 
For a considerable time I was induced to suppose that 
the swellings of the glands which thus took place after 
the cure of chancres were more the effect of accident 
than of the method of treatment, and that they would 
have occurred under whatever management the sores 
might have been. The frequency, however, of their 
appearance made me at last suspect that I was mista- 
ken, and farther observation made it obvious that ihi - 
was the ease. 

As experiment alone could determine the question, 
I was resolved to employ this test. Of the first twen- 
ty patients who occurred with incipient chancres, in 
ten they were destroyed by an immediate and effectu- 
al application of lunar caustic, the remedy being em- 
ployed according to my usual custom at that time, in- 
stantly on my being; called. Of the other ten, five 
were dressed with blue mercurial ointment, and live 
with common wax ointment. The sores to which, caw- 



See. v. or lues venerea. 'Ill 

tic were applied healed much sooner (ban the others, 
and next to these the sores that were dressed with mer- 
curial ointment. Bui to the ien patienisto whom caus- 
tic was applied no less than eight had buboes, while 
only one bubo occurred in all the others, and it hap- 
pened in one of the patients whose chancres had been 
dressed with mercury. I thought also that buboes ap- 
peared to be less frequent from the application of caus- 
tic where mercury had been previously given. This 
fell within my observation from time to time with pa- 
tients who had taken mercury either of their own ac- 
I or by the advice of others, and appearing to be 
of importance I was resolved to bring it likewise to 
the test of experiment, and the result was as follows : 
Of forty-eight patients with chancres in an incipient 
state, and exactly as they occurred in practice, one 
half was treated in the manner I have .mentioned, by 
destroying the chancres with caustic, immediately on 
my being desired to see them, while all the others 
were put under mercury for eight or ten days before 
the application of caustic. In every other circum- 
stance the method of treatment was the same. The 
difference, however, surprised me exceedingly. Of 
ttie twenty-four treated with the immediate application 
of caustic twenty were seized with buboes, while only 
three buboes occurred in an equal number to whom 
mercury had been previously administered. 

These buboes did not indeed all terminate in suppu- 
ration, nor did many of them arrive at any considera- 
ble size. Being closely watched, mercury was imme- 
diately applied for the purpose of discussing them, and 
for the most part it proved successful; but there was 
no cause to doubt of their being venereal from their 
being equally difficult to manage, and from those which 
ended in suppuration being equally difficult to cure 
with buboes which occur in the ordinary course of bu- 
siness. At first I was induced to hope that swellings 
produced in this, manner were not venereal, but mere- 
ly the effect of irritation excited bv the caustic, but 
it soon became obvious that this was not the case, and 
that caustic does notdestrov the venereal virus so com- 



212 OF THE CURE CI). IV. 

pletely as is commonly imagined, while, by the irrita- 
tion which it always in some degree excites, it tends 
often to produce buboes, which otherwise never would 
take place. This affords an additional proof to what 
has already been mentioned of the effect of irritation 
in exciting the action of the absorbents ; and the effect 
of mercury in this case, by preventing the formation 
of buboes, tends farther to support the opinion of this 
medicine acting as an antidote to the syphilitic virus. 

In most instances buboes produced in this manner 
begin to form in the course of a day or two after caus- 
tic has been applied ; in some cases even sooner. But 
I have known them take place where the glands had 
remained sound for a good many days after the chan- 
cres were completely cicatrised, and where there was 
no*reason therefore to suspect that any exciting cause 
of buboes could remain. In these instances I conclude 
that such a small- portion of the virus had been lodged 
in the lymphatics forming the gland, as required this 
length of time to excite that degree of irritation that 
is necessary for the production of bubo. 

The same effect appears to result from whatever 
caustic is employed ; at least this has been the case 
with such trials as I have made with lunar caustic, red 
precipitate, blue vitriol, and corrosive sublimate ; and 
as the caustic is more easily applied, while it common- 
ly acts with more certainty, and perhaps with less 
pain than any of the others, I commonly give it the 
preference. Where caustic is to be employed, my 
practice now is to put my patient previously under 
mercury for the space of six, eight, or ten days, till 
there is full evidence of the medicine having entered 
the system. At this time caustic is applied over the 
whole surface of the chancre, however extensive it 
may be, in such a manner as to destroy all the diseas- 
ed parts, and the application is renewed as often as the 
sores become foul or sloughy. In some it is not ne- 
cessary to use it above once or twice, while in others 
it must be repeated in every second or third day, dur- 
ing a great part of the cure. Even where the sores 
have become clean, caustic often proves useful, par- 



Sec. V. OF LUES VENEREA. 213 

ticularly when they are stationary, and make no pro- 
gress towards a cure; in which case we may common- 
ly make them cicatrise more speedily by the reiterated 
application of caustic than by any other remedy. 

When chancres are brought into a clean healing 
state a cure will for the most, part be obtained by con- 
tinuing the use of mercury for a sufficient length of 
time, and by dressing with dry lint, or any simple 
ointment; but that fixed or stationary state to which 
I allude, and in which they often remain where caus- 
tic is not frequently applied, is very effectually pre- 
vented by dressing with precipitate or calomel oint- 
ment; and in some cases I have employed for the 
same purpose an ointment prepared with verdigris.* 

In ail cases of chancres the parts ought to be kept 
particularly clean, and the best ordinary wash for this 
purpose is a weak solution of corrosive sublimate, in 
the proportion of one grain to seven or eight ounces 
of water. Where the sores remain foul notwithstand- 
ing the application of caustic, but which does not of- 
ten happen where a sufficient quantity of mercury is 
given along with it, it becomes necessary to employ a 
solution with a greater proportion of sublimate. In 
this case one, or even two grains, may be added to an 
ounce of water; but this being too strong for applying 
to the contiguous parts, care must be taken to confine 
it as much as possible to those that are diseased. In 
this foul or sloughy state of chancres, among the vari- 
ety of dressings which we are occasionally obliged to 
employ, the blue ointment prepared with equal parts 
of mercury and hogs-lard sometimes answers well, as 
it does indeed in almost every state of chancre in 
which it is proper. that mercury should be used. For 
the purpose too of removing this foul appearance which 
chancres are very apt to assume, and under which 
they never heal, red precipitate finely levigated is of- 
ten employed in powder, and frequently with advan- 
tage. Calomel applied in this manner also proves use- 
ful ; and it is chiefly in this state of chancres that I 

* Formula: of these ointments are given in the Appendix, Nos. 26, 27, and 28- 



214 OF THE CURE (Jh. IV. 

have perceived most advantage to be derived from 
mercurial fumigations. In all slight cases of chancres 
a free application of caustic very commonly proves 
successful ; but where the sores are deep, extensive, 
and very sloughy, together with the use of caustic we 
are obliged to employ one or other of the articles 
which I have mentioned ; and when precipitate, cal- 
omel, and even verdigris have failed, I have in various 
instances found that the parts have been rendered 
clean, and brought into a healing state, by fumigating 
once or twice with cinnabar. 

There are two states, however, of chancre which do 
not admit of this mode of treatment, viz. where the 
parts affected are either much inflamed, or show some 
tendency to mortification. In all other situations, 
whether the sores be upon the glans, prepuce, or free- 
num, or even within the mouth of the urethra, caus- 
tic may be applied with freedom. It may be proper 
here to remark, that when a chancre is seated upon 
the frasnum, or beneath it, if it is not altogether su- 
perficial, the freenum itself should be cut across. It 
is easily done, no inconvenience is experienced from 
if, and it tends always to forward the cure. 

When the parts upon which chancres are seated be- 
come much inflamed, such remedies should be em- 
ployed as prove most effectual in removing inflamma- 
tion. When the patient is plethoric, blood-letting in 
some instances is necessary, together with cooling laxa- 
tives, and a low diet. 

The parts should be dressed with any simple oint- 
ment, such as the common saturnine ointment and wax 
liniment mentioned in the Appendix.* In such cir- 
cumstances too, saturnine poultices prove sometimes 
useful ; but nothing ever gives more relief than the 
internal use of opiates. By allaying irritation they 
frequently tend more effectually than any other reme- 
dy to lessen or remove the inflammation. 

In some cases, however, notwithstanding all our at- 
tention, this inflammatory state of chancres terminates 

* Vide Nos. 29, and SO. 



Sec. V. OF LUES "VENEREA. 215 

in gangrene, while in others gangrene takes place 
where no great degree of inflammation had been pre- 
viously observed. In these opposite circumstances the 
remedies to be employed ought evidently to be dif- 
ferent. Where much inflammation still prevails, blood- 
letting with other parts of an anti-phlogistic course 
ought to be pushed as far as the strength and age of the 
patient can with safety admit, while a plentiful use of 
bark is perhaps the best remedy where little or no in- 
flammation occurs. 

For th e removal of inflammation, besides general 
blood-letting, I have occasionally ventured upon the 
application of leeches to the diseased parts, and com- 
monly with much advantage. The bites of leeches 
may in some instances give rise to venereal ulcers, 
which otherwise would not have taken place, but little 
or no disadvantage ensues from this, as they heal by 
the use of the mercury that we must necessarily em- 
ploy for the cure of the disease, while nothing proves 
so effectual as local blood-letting, for carrying offthat 
great degree of inflammatory tension which in cases of 
this description we sometimes meet with. 

Whether inflammation takes place or not, gangrene, 
when it arises from chancres, proceeds with more 
rapidity than it usually does from any other cause. I 
have known a considerable part of the glans destroy- 
ed by it in the course of a day. For the most part, if 
not immediately checked, either by general or local 
blood-letting, or by a liberal use of bark, according to 
the nature of the case, it proceeds without our being 
able to put a stop to it till it comes to the urethra. In 
different instances I have known the urethra laid en- 
tirely bare for a considerable length on the mortified 
parts being removed ; and where it begins upon tire 
preputium, it proceeds in some cases not only through 
the loose skin and cellular substance of the penis, but 
even into the corpora cavernosa. 

The most distressful symptom which takes place 
from the mortification of these parts is the vent which 
it sometimes gives to the urine by penetrating the sub- 
stance of the uretl T *n some instances one opening: 



216 OF THE CURE CI). IV, 

is formed ; in others we meet with two, three, or more, 
Besides the inconvenience and distress which this al- 
ways occasions it adds considerably to the hazard of 
the patient, for the urine in this manner finds access to 
the surrounding cellular substance, where it not only 
gives much additional pain, but the irritation which it 
excites seems to be of a nature particularly apt to cre- 
ate a disposition to gangrene, so that whenever it takes 
place the mortification extends more rapidly than 
it did before, nor has bark and the other remedies 
usually given much influence in putting a stop to it. 
We derive most advantage from opium. Whether 
opium acts here as an antiseptic may be difficult to as- 
certain : I rattier suppose that it proves chiefly useful 
by lessening or removing the irritation produced by the 
urine, for I have not perceived that its beneficial ef- 
fects are in proportion to the quantity that is given* 
Small doses, when they procure ease, seem to prove 
equally useful with the largest, which they would not 
probably do if they acted in any other manner. While 
by means of opiates we endeavour to lessen the pain, 
much care should be taken to prevent the urine from 
finding access to the contiguous parts. Where it hap- 
pens to lodge, the sac which receives it should be 
laid freely open, and the parts bathed with a decoction 
of bark, an infusion of rose leaves, or some other an- 
tiseptic after every time the patient voids urine, 

I have taken the more particular notice of this ef- 
fect of urine upon parts in this situation as I do not 
find that it has been mentioned by others, and as vari- 
ous cases have fallen under my care in which the most 
distressful consequences ensued from it. 

Chancres are particularly apt to become gangrenous 
when combined with paraphymosis, but they do so oc- 
casionally where no degree of this symptom has ever 
occurred. 

The most alarming symptom of this state of chancre 
is the hsemorrhagy which occurs when the mortification 
reaches the large arteries of the penis. No advantage 
is derived from tying these arteries with ligatures till 
the gangrene is completely stopped ; so thai in this 



Sec. V. OF LUES VENEBEA. 217 

situation we are obliged to trust to the uncertain ef- 
fects of astringent applications conjoined with mode- 
rate pressure. Pressure in this case is most effectual- 
ly applied by means of a fillet of linen or cotton, 
passed round the penis, after a leaden or silver tube 
has been inserted into the urethra. 

The point of most importance in this state of the 
disorder is to determine the propriety of giving mer- 
cury, or delaying the use of it till the mortification is 
over. It is the common practice to continue the mer- 
cury that had previously been given for the chancres, 
and many even judge it necessary to give it in greater 
quantities. In every instance, however, where I have 
known this done, it has evidently proved hurtful ; and 
having found from various trials that the mercury may 
with safety be laid aside during the progress of the 
mortification, I now never employ it till .all the morti- 
fied parts are removed. The fear of the disease gain- 
ing ground from this, and an opinion of the mortifica- 
tion being of a venereal nature, and that mercury is 
therefore necessary to stop it, is the cause of its being 
in general persisted in; but the progress of mortifica- 
tion is so rapid, when compared with the usual syrup-' 
ioms of syphilis, and it is in every circumstance so 
different in appearance from these, that I do not con- 
ceive it to be venereal. It is indeed evidently induced 
by this disease ; but in this respect the syphilitic virus 
seems to act in no other manner than as the occasional 
cause ; 'and chancres, being at first always local, I be- 
lieve, that in most instances the sore which remains af- 
ter the mortification is gone is not venereal, and that 
it would heal whether mercury should be given or not, 
in the same manner as would happen with a great pro- 
portion of chancres where caustic has been freely ap- 
plied on their first appearance. But as we cannot in 
either case know with certainty whether the virus has 
entered the system or not, the safety of our patient 
requires in both instances that mercury should be giv- 
en in such quantities as may be necessary to effect this 
purpose. While mortification continues to advance, it 
should be treated in the ^ame manner with gangrene 

VOL. II, 28 



218 OF THE CURE Ch. IV, 

i 

from any other cause, and without any regard to the 
venerea] disease: but as soon as the mortified parts 
are removed, the case should be considered as entirely 
venereal ; a course of mercury should be advised and 
continued from a fortnight to three weeks or a month, 
according to the virulence and obstinacy of the symp- 
toms after the sores are cicatrised. 

I have seldom, however, found it necessary to dis- 
continue mercury during the inflammatory state of 
chancres. Even where inflammation runs high, mercu- 
ry may be safely given. By lessening the venereal 
irritation, it tends for the most part to abate, and even 
to remove the inflammation, so that I commonly pre- 
scribe it immediately, and persist in the moderate use 
of it during the whole continuance of this symptom. 

After the inflammation produced by chancres 13 
gone they fall to be treated in the same manner as if 
this symptom had not taken place. When they are 
clean, and with a surface disposed to granulate and 
heal, any common ointment will answer for dressing 
them, but when foul or sloughy the application of 
caustic, calomel, precipitate, and verdigris are equally 
proper as if the inflammation had not happened. Ver- 
digris may not only be applied to chancres in powder, 
and in the form of an ointment, but in solution; and 
it equally tends to remove that sloughy foulness to 
which I allude, and disposes the sores to heal when 
they become stationary. It may be used in various 
proportions, from two grains to a, scruple in the ounce 
of water. 

In this clean state of chancres, when the cure doe$ 
not advance, the application of spirit of lavender, ar- 
dent spirits, or even of alcohol, proves sometimes 
useful; and in some cases we derive advantage from 
bathing the parts with lime water, a solution of blue 
vitriol, traumatic balsam, or tincture of myrrh. 

One of the greatest impediments to the cure of 
chancres is their taking place whether on the inside of 
the prepuce or upon the glans along with phymosis ; 
for when they cannot be kept clean and dressings prop- 
erly applied, the cure proves always both tedious and 



See. V. 0F LUES VENEREA. 219 

uncertain. In all slight cases of chancre in this situa- 
tion we endeavour to cure them by injecting from 
time to time, between the prepuce and glands, one or 
other of the articles I have just mentioned sufficiently di- 
luted; but when the sores are either deep or extensive 
the operation for the phymosis should always be advi- 
sed as the first part of the cute.* This being a meas- 
ure to which a patient does not readily assent it is 
commonly postponed, by which a great deal of time 
is lost, and chancres often allowed to proceed deep 
into the substance of the penis, which might easily 
have been healed without the hazard of this being in- 
cured. 

When an operation for this purpose becomes neces- 
sary the prepuce should be divided through its whole 
length. We are commonly desired to carry the incis- 
ion only the length of the chancres, but in different 
instances I have perceived bad consequences ensue 
from this. The undivided skin is apt to inflame and 
become tight, and the pain from the operation being 
nearly the same, the other as being more effectual and 
not productive of these inconveniences, should be 
preferred. 

When the cure, how T ever, is conducted without the 
prepuce being laid open, besides a very regular at- 
tention to cleanliness care should be taken to prevent 
adhesions between the preputium and gians ; a cir- 
cumstance particularly apt to happen when much in- 
flammation takes place, and fro n which a good deal 
of inconvenience is afterwards experienced. This is 
most effectually prevented by making such liquids as 
are injected pass freely round the whole substance of 
the gians, and inserting pledgits with proper dressings, 
and placing them between the prepuce and those parts 
of the glans that are affected. 

Chancres in the parts of generation of women re- 
quire the same method of treatment as in men. The 
parts do not appear to be so irritable, so that they 
more xeadiiy admit of the escharotic application? 

* Vide Chapter III Section XIJ 



220 OP THE CURE Ch. IV 

which I have mentioned. In both sexes the cure is 
much promoted by confinement while nothing tends 
more to retard it than the fretting of the parts by mo- 
tion in walking or riding on horseback. 

Where venereal sores form upon the mons veneris 
and external parts of the labia pudendi, or when chan- 
cres spread to these parts, as they sometimes do from 
the nympha3 clitoris, where they often begin, they are 
commonly more foul and sloughy than venereal sores 
in any other situation: Neither are they so readily 
cleaned by the usual dressings. Besides a more fre- 
quent application of lunar caustic they require any 
escharotics that we employ to be used in powder in 
^tead of being mixed with ointments. They even ad- 
mit of being covered from time to time with leviga- 
ted verdigris; nor have the milder articles of this 
class, such as calomel and red precipitate, the same 
influence in keeping them clean that we find them to 
have in venereal sores in almost every other part. It 
is proper, therefore, in the treatment of sores upon 
these parts, that this circumstance be kept in view. 

Lunar caustic is the best application for chancres 
upon the lips. In this situation ointments cannot be 
conveniently employed, we therefore trust almost en- 
tirely to the repeated application of caustic ; but in 
chancres upon the nipples the application of caustic 
creates so much pain that it ought never to be advis- 
ee}. We are therefore in these parts obliged to em- 
ploy the milder dressings, and nothing answers better 
than the common saturnine ointment, or wax oint- 
ment, with a fourth part of calomel. Some advan- 
tage is also derived from bathing the parts affected 
with a strong solution of opium in water. It lessens 
irritability, by which the sores are more readily dis- 
posed to heal. 



Our treatment of chancre has been already detailed at some 
length in the note on « the duration of a mercurial course, fee." 
page 159, extracted from Dr. Francis' paper on that subject, and 
the section on " Gold," as a remedy in lues venerea, page 206. 

Notwithstanding the reasons adduced for this practice and thq 



SeC. V. OF LUES VIKEREA. 221 

success with which, (so far as our experience goes) it has been 
attended, there are some practitioners of great authority who ad- 
vocate strenuously the plan of cure " under confinement," or as it 
may be more emphatically called the "cure by salivation," For 
this mode of treatment Mr. Howard and Dr. Adams are the two 
most illustrious champions, and as they have offered some very spe- 
cious reasons for their practice, we shall endeavour to give a short 
abstract of it for those who may not have been favoured with a pe- 
rusal of the original works. 

Mr. Howard in what he terms the early or ajxh thous chancre, ad- 
vises confinement, frictions, till there be foetorof the breath, slight 
affection of the mouth, with or without mercurial griping, or much 
increase of the salivary secretion towards the close of the course, 
principally by the latter doses of the medicine. Every friction, 
from the beginning to the end of the course, must be fairly perform- 
ed, for the space of half an hour, by the patient himself, with his 
naked hands. The dose originally begun with may after a little 
time, be doubled, trebled, or quadrupled, as circumstances di- 
rect. The effects of this course, is frequently obvious in eight 
or ten days and often before the mouth is affected, which is known 
by the base and callous edges of the chancre becoming soft and 
clean. The medicine should be continued not only till the chancre 
be healed, but till it be perfectly cicatrised, without the smallest 
degree of hardness remaining, and for a few days after. In this 
species of chancre, he advises no topical applications, but water 
and dry lint. As to the quantity of mercury necessary for a com- 
plete cure, he thinks one half of what would be required for a 
chancre of an old date, or a secondary affection, will be sufficient, 
provided the general effects be fair and unequivocal. Care should 
be taken that the connection between the several doses be preserved 
entire, without the interruption of a single day till there be a con- 
siderable accumulation. 

In the use of the remedy we are invariably to go from a small to 
a large dose, for if this order be inverted the course is checked, 
and the effects expected from it greatly weakened. The external 
marks of the decisive internal change are tenderness of the gums, 
foe tor of the breath, increased secretion of saliva, languor, pros- 
tration of strength, sudden emaciation ; sometimes with, some- 
times without a dysenteric affection of the bowels arising after 
a preceding costiveness. " In some cases the sore immediately 
heals upon the coming on of these symptoms ; when I say im- 
mediately, I mean in the short period of a night's time ; but in oth- 
ers it may be three, four or more days." When a dysenteric affection 
of the bowels occurs in consequence of mercury it should never be 
treated with any kind of purgative not even the most gentle, but 
the local irritation should be quieted by a warm opiate, such as the 
opiate confection. This course under confinement generally takes 
from fourteen to twenty-one or more days. 

In the next species of chancre, which is the same as the forego- 
ing except being of an older date, the same rules are to be pbserv- 
edj double the quantity of the remedy employed, and for a much 



2J2 OF THE CURE « Cll. IV. 

longer period, at all events till all the decisive effects of the remedy 
are visible. In what is termed irritable chancre, the same mode of 
treatment is applicable. If topics can be avoided, so much the bet- 
ter ; if the irritation be great, evacuations, cleanliness, opium, and 
rest, will generally give relief. Where phymosis takes place, rest 
is essentially necessary, and local treatment, as lotio ex calomel, et 
aq: rosar. employed. This lot'on should be injectedbe tween the 
glans and prepuce, while the specific is introduced in full doses. 
Opium is very useful in this stage. The last kind of chancre noti- 
ced by Mr. Howard is " the irritable, livid, spreading, moist kind 
of chancre." In this species he considers the use of topics indis- 
pensable, from the great irritability and uncommon acrimony of the 
discharge. In this case he makes use of the lotio ex calomel, and 
pushes the specific to the fullest extent, in order to prevent phy- 
mosis, and mortification of the glansand prepuce. The most pro- 
per time in every mercurial course for the application of a pow- 
erful topic to chancre seems to be only during the three or four days 
at the close of the course, when the medicine i« quickly producing 
its anti-venereal effects. In this case sedatives are useful. 

Doctor Adams prefers the method of cure by inunction, and if the 
patient will not submit to that, the crude mineral reduced by tritura- 
tion with some conserve, but objects strongly to all the mercurial 
salts. Should it affect the bowels, small doses of opium must be 
combined with it, and the pills taken shortly after a meal, avoiding 
every thing sour : The dose to be gradually increased, till the de- 
cisive effects are produced. This is known by the yielding of the 
callous edge and base of the chancre. As Dr. A. adopts the theory 
of Mr. Hunter, (counter irritation) he advises the excitement of 
the mercurial irritation, as expeditiously as the constitution of the 
patient will admit, for this purpose he directs the rubbing in of the 
ointment twice a day and the wearing of drawers, not wiping the 
ointment oft* in order that the absorption of it may continue. Sali- 
vation is the usual, but not a certain proof of mercurial irritation ; 
the first symptom of mercurial action is known by the starting of 
the gums before the angles of the teeth. In those constitutions, 
where the specific does not affect the mouth, the cure goes on nev- 
ertheless with the same regularity, as under the severest salivation. 
He thinks the chancre heals more readily by applying dry calomel 
to it during the frictions. 

When the frcenum has been the seat of chancre the patient should 
be careful not to indulge in venereal commerce for sometime after 
recovery, as the general consequence is a rupture of the part. But 
the best way is to divide the whole frsemlm at once. 

In phymosis, the penis should be kept in a perpendicular posture, 
parallel to the pubes, to prevent as much as possible the extravasa- 
ted lymph from subsiding and increasing the intermiscence. In 
the mean time the glans should be frequently washed, by means of 
a syringe, with a solution of oxymuriate of mercury in lime water, 
till the absorption of the extravasated juices, permits the denuda- 
tion of the glans and the treatment of the ulcers in the common way. 
Vide Howard on the Venereal, vol. 2, page 1.30. 

Adams on Poison?; quarto, page 116, 126* JEn. 



SeC. V. OF LUES VENEREA. 223 

$ 2. Of /Ae Cure of Buboes. 

A history of the rise and progress of bubo has al 
ready been given in sect. II. of this chapter, p. 20. 

Our treatment of bubo has varied and been improv- 
ed by the more perfect knowledge which of late years 
has been obtained in the anatomy of the lymphatic 
system. Till thi§ was acquired buboes were consider- 
ed as an effort of the system to throw off the morbific 
matter of the disease, so that in every instance to pro- 
mote their suppuration was thought to be necessary ; 
but now that it is known that they are not produced by 
any disease of the constitution; that they originate 
from a stoppage of the syphilitic virus in its progress 
to the common course of the circulation ; that by 
bringing mercury into contact with the virus while in 
this situation we can render it totally inert ; and that 
sores the consequence of the suppuration of buboes 
are difficult of cure, we do not hesitate to say that it 
is the best practice to prevent the formation of matter, 
and by a proper application of mercury, combined 
with other means, to procure a discussion of every 
tumour of this kind. 

But although the advantages of this practice are ob- 
vious to all who have given it a proper trial, stiM there 
are many who have not adopted it, as thinking that 
they lessen the hazard of the patient by inducing sup- 
puration in t tie substance of the gland, and afterwards 
discharging the matter, the consequence of the inflam- 
mation induced by the obstruction. 

We must indeed acknowledge that this reasoning 
would have every appearance of being well founded, 
and that the practice of curing buboes by discussion 
ought certainly to be exploded, was it to be accom- 
plished by forcing the matter of infection into the sys- 
tem, but as we have it in our power by a proper use 
of mercury entirely to destroy the nature of the mat- 
ter lodged in the obstructed gland, and as we know 
from daily observation, that when accomplished in 
nanner the discussion of buboes can never be pro- 
ductive of danger, it ought in all cases to be ad- 
vised. 



224 OF THE CURE Ch. IV, 

The discussion of these tumours might often be in 
our power by other means than the direct application 
of mercury to the matter of infection; but we act 
with more certainty of doing no harm to the consti- 
tution by first destroying the active property of the 
matter in the obstructed gland, and trusting after- 
wards to a proper course of mercury for obviating the 
effects of any part of the virus that may have passed 
into the system. 

On the first appearance of a bubo mercury should 
therefore be applied so as that it may with most cer- 
tainty pass into the obstructed gland. Hence it should 
be chiefly applied to those parts lying between the bu- 
bo and the spot at which the matter of infection was 
absorbed ; but in the ordinary seat of buboes the space 
lying between these points is not sufficient for the 
quantity of mercurial ointment that must be employ 
ed. Where buboes form in the arm pit, or in the fore 
part of the thigh from venereal sores in the hand or 
feet, this may at all times be done ; but when seated 
in the groin, besides rubbing the ointment on the 
parts lying between the chancres and the swellings, 
we also apply it along the inside of the thigh and leg- 
When the practice of discussing buboes with mercury 
was first introduced the ointment was chiefly rubbed 
upon the tumour, and in many instances a mercurial 
plaster was kept constantly applied to it ; we find; 
however, that the mercury passes with much more cer 
taint y into the gland by applying it to those parts from 
whence the lymphatic vessels forming the gland take 
their origin. 

But although a mercurial plaster applied upon the 
gland seems to do harm, by the heat and irritation 
which it excites, I am of opinion that a small portion 
of the ointment which we employ should be rub- 
bed upon it. Although none of it should by this route 
pass directly into the substance of the gland, still if 
will go into the system, and the discussion of the tu- 
mour is in many instances evidently promoted by 
gentle friction applied to it. 

Jn our application of mercury for the purpose of 



SeC. V, OF LUES VENEREA, 225 

making it pass through a particular gland it is evident 
that a knowledge of the course of the lymphatic ves- 
sels is a matter of importance; but we cannot always 
apply it, as we have already observed, to those parts 
from which the greatest number of lymphatics of the 
contiguous glands originate. Thus in women, where 
the bubo is sometimes seated within an inch or so of the 
seat of infection, which is the case where the glands 
upon the round ligaments become obstructed, as the 
lymphatics forming these glands arise perhaps chiefly 
from the tender skin of the labia pupendi, we cannot 
with propriety apply the ointment to these parts ; nor 
can we in most instances in the treatment of buboes in 
men take the advantages of those \y mphatics which 
originate in the glans penis in the internal surface of 
the prepuce or scrotum : at least wherever I have at- 
tempted to do so, however gently the friction was ap- 
plied, so much irritation was induced by it that there 
was an evident necessity for desisting. In the scrotum 
it is very apt to excite a fretful itchy eruption, and a 
considerable degree of uneasiness. In all these situa- 
tions, therefore, we must apply the ointment to the 
more firm skin of the contiguous parts. 

When the full quantity of mercury to be employed 
can be rubbed upon the leg and thigh of that side in 
which a bubo is seated, it ought certainly to be done, 
but the cure of the disease often requires a greater 
quantity of the ointment than can be used in this 
manner. In such cases we commonly apply it to the 
other thigh, but it may with equal safety and advan- 
tage be rubbed upon the arms or any part of the body. 

From what has been said, it will appear that we de- 
pend chiefly upon a proper application of mercury 
for the discussion of buboes ; but we ought by no 
means to trust entirely to this. When the patient is 
plethoric he should immediately lose blood, in quanti- 
ty proportioned to his strength, and his bowels should 
be opened by a brisk purgative, It proves sometimes 
serviceable to repeat the purgative once and again : 
Cold saturnine poultices should be applied to the tu 
mour : The patient should be kept at perfect rest : His 

vol. ii. 29 



226 OF THE CURE Ch. IV. 

diet should be moderate; and where much irritation 
prevails opiates should be given in such doses as are 
sufficient for removing it. I think it right indeed to 
observe, that in the treatment of buboes much advan- 
tage may be derived from the use of opiates, and that 
mercury will often fail if we do not at the same time 
lessen or remove the irritation and pain, for which no- 
thing answers with such certainty as the internal use of 
opiates combined with a frequent renewal of cold sat- 
urnine applications. In some instances I have made 
trial of local blood-letting by means of leeches for the 
discussion of venereal buboes, and in some cases with 
advantage. In others, however, it has not proved so 
serviceable as this remedy commonly does in swellings 
of these parts that proceed entirely from inflammation. 
On the contrary, the irritation excited by the oites of 
these animals has in some appeared to do harm. 

By a proper application of the remedies thai have 
been enumerated we endeavour to carry off any in- 
flammation that may have taken place in the tumour, 
while by a due continuation of mercury we secure the 
safety of the constitution. The length of time to which 
a course of mercnry should extend for this purpose 
can only be ascertained by the effects w hie h result from 
it. It ought always, however, to be continued till the 
swelled gland is nearly reduced to its natural size; and 
when chancres take place along with it, the mercury 
cannot with safety be laid aside till the sores have 
been cicatrised for two or three weeks. But in atten- 
ding to the discussion of the tumour we have no rea- 
son in any case to expect that it will be reduced alto- 
gether to its usual size ; for lymphatic glands when swel 
led from this cause commonly remain for a great 
length of time, and in some instances during the life 
of the patient, somewhat more full and prominent 
than they were before. All we have to expect there- 
fore is, that they should fall nearly to their natural 
size, and be entirely free of pain. This being accom- 
plished, if no chancres or other symptoms of the dis- 
ease exist, and if the full effect" of the mercury has 



SeC. V. OF LUES VENEREA. 227 

been kept up, it may with safety be left off at the end 
of a fortnight. 

In buboes altogether venereal we commonly suc- 
ceed in removing them by discussion, where the pa- 
tient applies in due time and gives that attention which 
he ought to do to the application of the remedies ; but 
in various instances we fail, and notwithstanding all 
our endeavours, the tumour proceeds to suppuration. 
This may take place from various causes, but it hap- 
pens chiefly from patients delaying too long to ask 
for assistance; from their improper manner of living, 
and being allowed to walk about when they ought to 
be confined ; from their not applying the mercury with 
that care and attention which it requires; and in many 
instances from the patient being of a scrophulous con- 
stitution; by which although the syphilitic virus may 
be removed or destroyed by the mercury, still it is not 
sufficient for the purpose of carrying off that tenden- 
cy to the formation of matter in the gland which the 
"virus has produced. 

As soon as a bubo shews any tendency to suppurate, 
k is the practice with many to endeavour to promote 
the formation of matter as speedily as possible ; but 
I have not found that there is any good reason for this. 
By still proceeding with an attentive application of 
mercury, and with the use of cold applications, we 
frequently succeed in the discussions of these tumours 
after they have arrived at a considerable bulk, and in 
some instances even after some partial suppuration 
has taken place. Neither does any harm occur from 
the practice when it does not succeed ; for although 
complete suppuration should afterwards take place, 
we do not perceive that the process is retarded by the 
mercury having been continued, while the sores which 
ensue heal more kindly than they usually do where 
the mercury has been previously laid aside. By some 
we are told, that the use of mercury, during the for- 
mation of buboes, ought never to be advised; but al- 
though I have paid much attention to the subject I 
have never perceived that in any instance it has done 
harm, while, besides other advantages, it saves a good' 



228 OF THE CURE Ch. IV. 

deal of time which otherwise would be lost. Even 
where the formation of matter has taken place to a 
considerable extent, and, where it is therefore proper 
io promote the complete suppuration of the tumour by 
the frequent renewal of warm emollient poultices and 
fomentations, still there is no necessity for desisting; 
from the use of mercurv, which ought to be corvtmu- 
ed without interruption till a sufficient quantity is em- 
ployed for the safety of the constitution. It does not 
prevent the suppuration from going forward; and the 
sores which ensue from the discharge of the matter 
heal mere readily, as we have already observed, when 
no interruption has been given to the exhibition of 
mercurv. 

When buboes have come to a state of suppuration 
it is a question with some whether they should be 
opened or not, for many have observed that they fre- 
quently heal easily when they are allowed to burst, 
by which the pain and terror of the operation is avoid- 
ed. The result of my observation has been, that 
when buboes do not arrive at any great size we should 
proceed with the use of mercury till they burst of 
themselves, unless where the teguments are unusually 
thick ; but when the substance of the gland is entirely 
suppurated, as the matter, if thickly covered, would 
be a long while in getting out, and as it might in the 
mean time insinuate among the surrounding parts, in 
order to prevent the inconveniencies which this would 
induce, we ought certainly to make an opening into 
it; and in all cases of large buboes we should not he- 
sitate in advising them to be opened. 

Our object in opening buboes should be nearly the 
same as in other purulent collections. Such an open- 
ing should be made as will afford a free vent to the mat- 
ter, but there is no necessity for making it larger. In 
very large buboes, indeed, the teguments are apt to be so 
loose and flabby, and the texture of the skin so much 
destroyed, that the cure would be rendered tedious 
was the skin allowed to remain. In such cases I some- 
times discharge the matter with caustic, applied in 
such a manner as to destroy an^ part of the teguments 



Sec. V. OF LUES VENEREA, 229 

that appear to be superabundant. This, however, ig 
not often necessary; and for the most parti have 
found that an opening made from the centre of the tu- 
mour, where the matter commonly points down to the 
most depending part of it, is perfectly sufficient. Even 
a smaller opening than this would often answer ; but it 
is better to make it of a sufficient size at once than to be 
obliged to repeat a very painful operation perhaps once 
and again, as is often necessary where buboes of a 
large size are opened with small incisions. I need 
scarcely observe that the opening should in every in-* 
stance be continued down to the most depending point 
of the collection. From want of sufficient attention 
to this we meet with daily instances of the matter be- 
ing allowed to collect, and in this manner to find ac- 
cess to the contiguous parts, by which a great deal of 
distress is induced, which, with due care at first, might 
easily have been prevented. 

This I may observe is a point of the first importance 
in the treatment of buboes, but it does not often meet 
with that attention which it merits. Patients under 
mercury being for the most part highly irritable, they 
seldom submit easily to have buboes properly opened ; 
so that although the lancet may be entered at the most 
prominent part of the tumour, which it ought always 
to be, the practitioner, if not firm and resolute, is of- 
ten prevented from carrying it to the most depending 
part of it, by which some space is left for the lodge- 
ment of matter; and however small this at first may 
be, it seldom fails of becoming more extensive. This 
again gives rise to a great extent of ulcer, or to the 
formation of sinuses, which very constantly prove the 
source of much pain to the patient, and of distress and 
embarrassment to the surgeon. 

When sinuses in this situation are superficial, and run 
little deeper than the skin, they are easily managed. 
jNo risk is incurred in laying them open, by which, if 
the constitution is healthy, a cure will be obtained on 
a sufficient quantity of mercury being given ; but they 
sometimes run deep, and pass so near to the large 
blood-vessels of these parts., that no attempt of this 



230 OF THE CURE Ch. IV. 

Jdnd can with safety be made. In such circumstances 
all that art can in general do is to preserve the exter- 
nal opening of the sinuses sufficiently large, and by 
regular and equal pressure at the different dressings, 
to prevent as much as possihle the matter from lodging. 
In some instances I have derived advantage from in- 
serting, from time to time, a piece of caustic to the 
bottom of a deep sinus, and applying it gently over 
the whole internal surface of the sore. In others, the 
insertion of a small portion of ointment impregnated 
with red precipitate has proved useful. By removing 
the sloughs with which the surface of these sinuses are 
commonly covered, they thus excite a disposition over 
the whole to granulate and unite. 

When buboes come forward to full maturation with- 
out much injury being done to the skin, I have in dif- 
ferent instances, discharged the matter by the intro- 
duction of a small cord or seton, and the practice has 
succeeded. This requires, however, the teguments 
to be firmer than they commonly are when a bubo is 
ready to be opened. 

It is universally admitted that it is of much import- 
ance to prevent the air from finding access to sores; 
and as we sometimes observe buboes ooze out the mat- 
ter which they contain by a number of small openings, 
and as these openings commonly heal easily, I con- 
clude that they do so from their being so small as. to 
exclude the air entirely. In different instances I have 
attempted to imitate nature, by making a number of 
small punctures with the point of a lancet over the 
whole extent of the bubo, and for the most part with 
success. The matter in this manner comes slowly off; 
the sides of the abscess contract gradually ; and when 
completely emptied, w>e find the whole parts that have 
been affected sufficiently firm without any sores or si- 
nuses remaining. 

When the patient has taken a sufficient quantity of 
mercury, if the constitution in other respects is sound, 
the sore in most instances heals easily, merely by dres- 
sing with common cerate, and by that attention to 
cleanliness which in the treatment of sores of every 



Sec. v. or lues venerea. 231 

description is necessary. It often happens however 
that the cure of these sores proves tedious, notwith= 
standing all the attention that we can give to them, 
Their edges become hard, livid, and often retorted ; 
the matter thin, sharp, and foetid; and instead of heal- 
ing, the ulceration gradually extends, or, if it heals in 
some parts - it breaks out in others, giving a honey-comb 
appearance to all the contiguous parts. In some in- 
stances the tendency to this depascent kind of sore is 
so great that it soon spreads over all the under part of 
the abdomen, and upper parts of the thigh ; in some 
cases by the matter being so acrid as to corrode and 
destroy all the contiguous parts with which it comes in 
contact, and in others by spreading beneath the skin, 
and bursting out from time to time in a variety of 
small ulcers. 

The situation of patients with sores of this descrip- 
tion is often very deplorable. The pain with which 
they are attended is commonly severe ; the acrid mat- 
ter which they afford being absorbed, hectic fever is 
thereby induced ; the patient becomes hot and restless 
through the night; and almost a total want of appe- 
tite renders them soon much emaciated. 

In such circumstances cicuta has sometimes proved 
useful ; and in different instances the sores have been 
healed by it when no advantage was derived from a™ 
ny kind of ointment. In these cases it was applied in 
the form of poultices, commonly by mixing the juice 
of the fresh herb with emollient cataplasms. I have 
also observed that the recent expressed juice has, for 
internal use, proved more effectual than any other 
form of it. I have employed hyoscyamus and bella- 
dona fully, but seldom with any material advantage. 
Neither have I in these cases observed any obvious be- 
nefit from sarsaparilla ; but in different instances me- 
zereon, guiacum, and sarsaparilla combined have pro- 
ved useful, when exhibited in the manner I have a! 
ready mentioned. 

The most effectual course, however, which I have 
employed, is the application of caustic round all the 
edges and hardened parts of the sores, conjoined with 



262 OP THE CURE Ch. IV. 

the internal use of opium. For a considerable time I 
trusted entirely to dressings of the emollient kind, be- 
ing afraid of irritating parts already highly sensible. 
In some cas^s a saturnine ointment has proved success- 
ful, and in others the common calamine cerate has an- 
swered ; but in most instances, on those days in which 
caustic is not applied I have found more advantage 
from dressing with ointments prepared with a consid- 
erable proportion of calomel, red precipitate, or ver- 
digris.* In some cases it is necessary to sprinkle these 
articles over the sores in the form of powder, but for 
the most part they are sufficiently powerful when 
mixed with ointments. Instead of exciting pain, as 
those not accustomed to use them are apt to suspect, 
they commonly remove it; and they seldom fail to al- 
ter the discharge from a thin acrid sanies, to a well 
digested pus. 

The application of lunar caustic indeed always ex- 
cites pain at first, but this soon subsides, especially 
when the internal exhibition of opium is advised a- 
long with it. Indeed opium of itself proves often use- 
ful in sores of this description, not by acting, as some 
have imagined, as an antisyphilitic remedy but by re- 
moving, as I have already had occasion to observe, that 
pain and irritation with which sores discharging acrid 
matter are usually accompanied. By removing this 
state of irritability it destroys the disposition in the 
vessels of the sore to form that kind of matter, which, 
by its own acrimony, serves to perpetuate the ulcera- 
tion ; and this being accomplished, when no other in- 
terruption takes place, nature alone seldom fails to 
complete the cure. 

In some instances I have known sores in this situa- 
tion which resisted every other remedy soon healed by 
being fumigated from time to time with cinnabar: In 
others warm salt-water bathing, and afterward the or- 
dinary form of sea-bathing has proved useful; while 
in some a cure has not been obtained but with an en- 

* Vide Appendix, Nos. 26, 37, 38 



SeC. V. OF LUES VENEREA,. 233 

tire change of regimen. Where the patient has pre- 
viously lived upon milk and vegetables a moderate al- 
lowance of wine and animal food has proved service= 
able, while those who have previously been accustom- 
ed to full living have derived much advantage from 
a diet consisting altogether of vegetables and milk. In 
all such cases country air proves particularly useful. 

Where mercurial fumigations are employed for the 
cure of these sores they should be conveyed to the 
parts affected by metallic tubes, and kept applied to 
them for the space of twenty-five minutes or half an 
hour at once, and this should be repeated every second 
or third day, for six or eight times. 

For some time past I have been making trial of the 
muriated barytes, a remedy lately brought into notice 
by the ingenious Dr. Crawford of London.* These 
trials have been chiefly confined to sores and tumours 
produced by scrophula, but I have also made use of it 
in some of those spreading ulcers which we are now 
considering, after there was no cause to doubt of the 
syphilitic virus being eradicated, and in some instances 
1 think with advantage. I have not as yet, however, 
given it in a sufficient number of cases to be able to 
speak of it with precision. 

Besides this state of bubo there is another which in 
some instances proves very distressful, in which the tu- 
mour, after arriving at a considerable bulk, remains 
nearly stationary, and shews no tendency either to sup- 
purate or dissolve, notwithstanding of all the remedies 
we may employ. 

For the most part this indolent state of bubo depends 
upon the patient being of a scrophulous constitution ; 
but whatever may be the cause, our first object should 
be to employ that quantity of mercury which may ap- 
pear to be necessary for rendering the system safe. 

Unction affords here likewise the best form of using 
mercury ; by making it pass through the diseased parts 
discussion of the tumour is more readily accomplished 

* Vide Appendix, No. 32. 
VOL, XL 30 



■I 



234 OF THE CURL Cb. IV, 

than when the medicine is given by the mouth. Even 
this, however, will in some instances be continued 
without any advantage for a great length of time. Tn 
such circumstances I have in various cases advised blis- 
ters to be repeatedly applied over the tumours. They 
never do harm, and in some cases they have proved 
evidently useful. In others electricity has proved ser- 
viceable, but it is necessary to continue it for several 
weeks in order to judge of its influence ; and it ought 
to be continued longer at each time of applying it than 
is usually done. In four cases of indolent tumours 
where electricity proved successful, and two of these 
were of the kind we are now considering, no advantage 
was derived from the common way of using it. In all 
of these it was applied for the space of half an hour 
at once; this was repeated three times a-day, and at 
each application sparks were not only taken from the 
surface of the tumours, but gentle shocks were passed 
through them. For the first two or three weeks scarce- 
ly any alteration was perceived in any of them, but 
they all decreased suddenly at last. One of them of 
considerable size, which had been of eight months du- 
ration, and in some parts of which matter seemed to 
have formed, was reduced to the fourth part of its bulk 
in the course of a few days from the period at which 
it began to diminish. In this state of these tumours a 
long continued use of cicuta proves sometimes service- 
able ; and I have seen evident advantages from sea- 
bathing, and from drinking as much salt water daily 
as the patient can bear without being much purged. 

Before entering upon the use of cold bathing I have 
in some cases advised warm salt water to be poured 
upon the swelling morning and evening, for the space 
of two or three weeks, and for the most part it has ap- 
peared to prove useful. 

In the course of time buboes in this state sometimes 
become soft, and shew a tendency to suppurate, al- 
though they may not have done so before. It is here 
that I have observed the warm gum plasters prove most 
useful. By stimulating the vessels of the diseased 



SeC. V, OF LUES VENEREA* 235 

part? they seem to excite that kind of effusion which 
readily proceeds to a state of purulency. 

But the most alarming circumstance to patients with 
tumours in this indolent state, is, a suspicion which 
they are apt to entertain that they may some time or 
other end in cancer. This is, however, so rare an oc- 
currence, that it should scarcely give any cause of a- 
larm. The phagedenic sores which occasionally suc- 
ceed to buboes, and of which we have already taken 
notice, sometimes put on a cancerous appearance, but 
the real sehirrhus which terminates in cancer is rarely 
if ever the consequence of a venereal bubo. In dif 
ferent instances I have been consulted for indolent hi- 
m<Hirs in these parts on suspicion of their being can- 
cerous but I conclude that they are seldom or never of 
this nature, from all of them having done well where 
the patients have been persuaded not to meddle with 
them. They often indeed remain considerably en- 
larged for a great length of time; but when they do 
not ulcerate no danger is to be dreaded. Wherever 
parts in this situation, however, become cancerous, 
they ought to be extirpated while they remain in 3 
moveable slate. 



With regard to the cure of this troublesome symptom of Luesj 
we have little to add to the observations of our author. We have 
frequently experienced the good effects of Epispastics, in the early 
stage of bubo, and feel confident that a judicious application of them 
will often prevent suppuration.-^-Should suppuration, however, 
take place, as it frequently will in spile of every means to prevent 
it, the tumour ought to be suffered to break of itself, and thattermi° 
nation promoted by emollient cataplasms. If the method of cure by 
confinement be really adviseable in any case, it is during the inflam = 
matoi y stage of bubo, when the irritability is great, and liable to be 
increased by the slightest degree of exercise, 

For further information on the treatment of buboes, we refer to 
Howard, Vol. II. page 30, — To the Dissertation of Dr. Francis, 
vide note page 164. and to Doctor Adams on Poisons, quarto, page 
129, Ed. 



' 



236 OF THE CURE Ch. IV. 



$ X Of the Cure of Venereal Ulcers. 

In the two preceding sections we have treated of the 
cure of chanties, and of those ulcers which succeed to 
buboes, both of which, but particularly the first, may 
be considered as primary symptoms of the disease, as 
they may take place without the system being in any 
degree injured. At present we have to consider the 
treatment of those ulcers which originate from the sy- 
philitic virus having entered the constitution, and of 
which a description has been given in the second sec- 
tion of this chapter, page 42. 

In the management of these ulcers our chief depend- 
ence is upon a well-regulated course of mercury; and 
I believe, that in general it is the best practice to trust 
in tiie first instance to mercury alone, and not to has- 
ten the healing of the sores by any other means than 
the application of mild dressings and due attention to 
cleanliness. Under this treatment we rest assured that 
the cure is altogether accomplished by the destruction 
of the virus, which must always be a more doubtful 
question where caustic remedies have been employed. 

There are some exceptions, however, to this, and I 
consider it as of much importance in practice that they 
be kept in view. Venereal sores may be so situated, 
and in such a state that their farther progress may be 
attended with the loss of parts materially necessary 
foi life, or for the future comfort of the patient, as is 
the case with ulcers that have already penetrated deep 
in the throat, mouth, nose, lips or face. In all these 
situations, particularly in the throat, nose, and tips, 
they usually proceed with more rapidity than in other 
parts of the body, so that by trusting to the internal 
use of mercury alone such a destruction of parts often 
takes place as proves afterwards highly distressful. On 
this account the cure ought to be hastened as much as 
possible by the use of such dressings as we find from ex- 
perience prove most effectual ; and no harm can ensue 
from this being conjoined with whatever quantity of 
meicury may be required. 



SeC. V. OF LUES VENEREA. 23? 

In all sores truly venereal, wherever they may be 
situated, the parts are most speedily brought to a heal- 
ing condition by a free application of caustic, but the 
practice has seldom, I believe, been considered as ap- 
plicable to ulcers in the mouth, throat, or internal 
parts of the nose. For many years past, however, I 
have been in the practice of using caustic as well as 
other escharotics in the cure of these ulcers with the 
greatest freedom. No danger has ever ensued from 
it ; and in various instances it has contributed to save 
the uvula and other parts of the throat, which other- 
wise were in great danger of being destroyed. Caus- 
tic fixed in a tube six or seven inches in length may be 
easily conveyed to any part of the mjuth or throat, 
and the tube answers the purpose whether it be curved 
or straight. Caustic excites less pain in these parts 
than it usually does in other parts of the body, and it 
seldom fails to remove the irritation which accompa- 
nies these ulcers, and in this manner to dispose them 
to heal. One application seldom proves sufficient. 
Till the mercury has completely entered the system, it 
requires to be repeated once and again, perhaps every 
second or third day, and in the intermediate days I 
cause the parts to be touched occasionally either with 
a weak solution of corrosive sublimate or with a strong 
impregnation of honey with mercury, which in all 
sores of this description is a very useful application.* 

In the description which I have given of the vene- 
real sore throat, page 37 of this volume, I have en- 
deavoured to point out marks of distinction between 
it and affections of the throat, the consequences of 
other causes, and particularly those by which it may 
be distinguished from ulcerations of the mouth and 
throat which mercury is apt to induce. Among other 
means of distinction may be mentioned the different 
effects produced upon them by caustic. In the true 
venereal ulcer, after the first irritation which it excites 
is over, a good deal of relief is obtained from it, and 
the parts soon assume a clean healing appearance ; 

* Vide Appendix, No. 5, 



238 OP THE CURE Ch. IV. 

whereas, in sores induced by mercury the application 
of caustic not only gives very intense pain at first, but 
this is apt to continue for a considerable time, while 
the sores retain nearly the same appearances, however 
frequently the remedy may be repeated. 

In the nose and outer parts of the lips, these ulcers 
besides being touched with caustic, may be dressed 
with ointments impregnated with calomel, red precip- 
itate, and even with verdigris ; but these remedies are 
inadmissible to the throat and inside of the mouth from 
the danger that would ensue from their passing into the 
stomach. 

Even in venereal ulcers of other parts of the body 
we are often obliged at last to employ remedies of this 
class. For the most part they become clean soon after 
mercury is taken in sufficient quantity for rendering 
the mouth sore, and they frequently heal, merely by 
continuing the course of mercury for a sufficient length 
of time. But this does not always happen; for al- 
though the sores may become clean, and even con- 
tract, they are very apt to become stationary at last ; 
and do not show any disposition to heal, however long 
the mercury may be continued. When we perceive 
this to be the case, the mild dressings which we em- 
ployed at first should be laid aside. The parts should 
be completely touched with lunar caustic every second 
or third day, and at other times dressed with calomel, 
or red precipitate ointment. In some cases we suc- 
ceed by bathing with a weak solution of corrosive sub- 
limate, or verdigris ; but the ointments for the most- 
part prove more effectual. 

By thus connecting a regular attention to the exter- 
nal management of the sores, with a due perseverance 
in the use of mercury, we very commonly prove suc- 
cessful at last ; but even this does not always answer. 
In some instances, the ulcers instead of becoming clean 
and putting on a healing appearance, remain foul and 
equally extensive as at Kirst. 

In such circumstances we sometimes succeed by 
changing the preparation of mercury, and in others by 
making some variety in the dressings applied to the 



Sec. V. OF LUES VENEREA. 239 

sores. We should not, therefore, rest satisfied with 
one mode of treatment, but where no advantage is ob- 
tained from the second or third variation of the reme- 
dies, particularly if the caustic has been sufficiently 
powerful, and the mouth kept for a due length of time 
completely sore with the mercury, we may in that 
case be assured either that some other disease prevails 
in the system or that the sores are rendered obstinate 
by an affection of the contiguous parts. 

Scrophula and scurvy are the diseases of the consti- 
tution by which the cure of these sores is most apt to 
be obstructed. Venereal ulcers will no doubt heal in 
scrophulous constitutions. Of this we have daily in- 
stances; but it is equally certain that the contrary of- 
ten happens, and with such certainty does scurvy ob- 
struct the operation of mercury that a cure can scarce- 
ly be obtained as we have already observed, of any of 
the more inveterate symptoms of syphilis while the 
scorbutic diathesis exists in any considerable degree. 
Where either of these diseases is therefore found to 
be the cause of our failure, those remedies must be 
employed which prove most successful in removing 
them, but having already in different parts of this 
work had occasion to speak particularly upon this sub- 
ject, it will not here be necessary to consider it farther. 

The local affection which occurs as the most frequent 
impediment to the cure of these sores, is a diseased 
state of the bones above which they are seated, or of 
the membranes covering these bones. In either of 
these cases, although the virus of the disease may be 
eradicated by a course of mercury, still the sores will 
continue foul, nor will they show any tendency to 
heal, however long the mercury may be continued. 
Ulcers of this description being frequently connected 
with this diseased state of the parts beneath are often 
the cause of more mercury being employed than would 
otherwise be judged necessary, for we are too apt to 
suppose that all such sores as were at first produced by 
Lues Venerea are to be cured by mercury alone ; an 
error thai has been the cause of much mercury being 
very unnecessarily given. 



^40 OF THE CURE Ch. !V e 

Whether the bone, or only the periosteum be at first 
affected, our practice must be nearly the same; for in 
such circumstances, where the periosteum is so much 
diseased as to resist the effects of a full course of mer- 
cury, there must ultimately be a partial exfoliation of 
the bone beneath, before a permanent cure will take 
place. The soft unhealthy granulations with which 
sores in this state are apt to be covered must be de- 
stroyed with proper escharotics, and the exfoliation of 
the bone must be promoted by all such means as usu- 
ally prove most effectual for that purpose, and for 
"which books on surgery may be consulted. I may 
here shortly observe, that the best escharotic I have 
employed for the destruction of these fungous excres- 
cences which sprout upon the surface of the diseased 
bones is a combination of red precipitate and calcined 
alum, which proves much more powerful than either 
of these articles when used separately, and more ef- 
fectual even than caustic in the usual way of apply- 
ing it;* 

On the diseased parts of the bone being removed a 
cure will soon take place if a sufficient quantity of 
mercury has been given; otherwise the sore will as- 
sume the usual appearances of a venereal ulcer, and 
will not heal till another course of mercury is advised. 

With respect to the quantity of mercury to be giv- 
en for the cure of venereal ulcers, this must at all times 
be regulated by the effects which result from it, and 
these again will in a great measure depend upon the 
duration of the disease. When the disease has been 
of short continuance, and the sores heal easily with- 
out the assistance of external applications, the mercu- 
ry, if given in full quantity, need never be continued 
•above three weeks after they are cicatrised ; but we 
should proceed with it for the space of a month where 
the system has either been long infected, or where we 
have judged it necessary to heal the sores quickly by 
the application of caustic or escharotics. Thus, in an 
ulcer in the throat, which we might suppose would 

* A prescription is given for this article Na 44, Appendix to Vol. I. 



BeC. Vo OF LUES VENEREA. 241 

require the patient to be under mercury for the space 
of a fortnight, merely in order to cicatrise it, and for 
another fortnight, that is, for the space of a month in 
all, in order to render his constitution safe, if by the 
application of caustic the ulcer shall be cicatrised in a 
week, the mercury should be persisted in for a month 
thereafter, or for five weeks in all. 

By some it has been doubted whether it is necessary 
to persevere in the use of mercury after the symptoms 
for which it is given are removed; but these doubts 
have only been suggested by those, who, from want 
of sufficient experience are not capable of judging, or 
by others who in the support of a theory which they 
have adopted, allow their judgments to be so far per- 
verted that they lose sight of every fact and argument 
that militates against it. There is nothing more cer- 
tain than that venereal ulcers, as well as every other 
symptom of the disease, may be completely removed 
by mercury, and yet that the disease will return in the 
same or some other form, if we do not persist in the 
use of mercury for some time thereafter ; that is, the 
disease itself may be cured while the disposition re- 
mains. All the symptoms may be carried off entire- 
ly, and yet the virus subsist in such force that they 
will at some future period break out again. The 
length of time to which the use of mercury should be 
protracted for removing this disposition it is not al- 
ways easy to ascertain. In this and some of the pre- 
ceding sections I have mentioned the result of my own 
experience upon this point, but this can only be done, 
in general terms, and the quantity of mercury to be 
given in any particular case must in a great measure 
be regulated by the judgment of the practitioner in 
attendance. 

Towards the close of a mercurial course employed 
for the cure of venereal ulcers of long duration, de- 
coctions ot sarsaparilla, mezereon, and guiacum are 
sometimes given with advantage. The latter I have 
already mentioned as the most effectual of these, but 
in some instances a combination of the whole has ap= 
peared to prove more powerful than anyone of them 

vol. ii. 31 



242 OF THE CURE Ch, IV, 

used separately. Many alledge that no advantage is 
derived from any of these ; but although I was once 
of this opinion I am now perfectly convinced that ul- 
cers of this description frequently heal more easily 
when a mercurial course is conjoined with a decoction 
such as I have mentioned, than when the mercury is 
given entirely by itself. 

In these ulcers, when much irritation prevails, opi- 
um proves particularly useful. I have in various in- 
stances, indeed, found that all other remedies are of 
no avail till this irritability of the parts is removed. 
In some cases this may be done with hyoscyamus. 
Three or four grains of the extract given at bed time 
very commonly acts as an anodyne, and I conclude 
that cicuta, when it proves useful here, acts also in 
this manner; but when the irritation is considerable 
opium is the only remedy upon which we can depend. 
It ought therefore in all cases to be given where the 
sores do not soon become perfectly easy on the mer- 
cury taking full effect, and which they commonly do 
when they are altogether venereal. 



When the ulceration of the throat is considered venereal by the 
practitioner, the relief administered should be speedy, as the ulcer 
spreads rapidly to the uvula, and if that pait be destroyed, an in- 
curable defect in the voice will remain ever after. To accelerate 
the action of the general remedy, fumigation with cinnabar has been 
advised by some writers. This, however, is not to be used in those 
patients whose lungs are irritable or who have a tendency to hectic. 
In this case, a mild mercurial in the form of a gargle may be pre- 
scribed and we have found particular benefit from a solution of the 
corrosive sublimate in water. Should the ulceration be rapid in its 
progress, large doses of mercury ought to be given, in order to in- 
duce a rapid salivation. 

Venereal sores of the skin, ulceration of the posterior part of the 
oesophagus, of the tongue or cheeks are curable by the same gene- 
ral mea.)s as before, and to thes§ symptoms mercurial topics are 
sometimes though rarely necessary. Mr. Howard observes that 
he has seen a venereal sore of the skin so highly irritable, that the 
patient felt excruciating pain during the dressing, until the system 
and mouth became affected with mercury, when it completely sub- 
sided. A similar treatment is adviseable in cases of Venereal Ozae- 
na. Ed> 



Sec. V. OF LUES VENEREA. 243 

$ 4. Of the Cure of Venereal Blotehes. 

A description of this symptom is given in Section 
II. of this Chapter, p. 50. 

Almost the only remedy employed for the cure of 
venereal blotches is mercury, and when the course is 
well conducted it seldom fails. We never find it ne- 
cessary to have recourse to external applications unless 
the eruptions* become hot and uneasy, in which case 
relief is sometimes obtained from dusting the parts 
with (lour or starch powder, as is done in cases of ery- 
sipelas. 

Where the usual method of exhibiting mercury has 
failed in the cure of these eruptions, corrosive subli- 
mate has appeared to prove useful ; but as the medi- 
cine in this form cannot be given in large quantities, it 
requires to be continued for a great length of time. 
It should be regularly given for at least six weeks af?- 
ter the blotches have disappeared ; and it seems to op- 
erate with most, certainty when conjoined with the de- 
coction which I have just had occasion to mention. 
The Lisbon diet-drink is said to have proved particu- 
larly useful in the cure of this symptom.* Antimoni- 
als, from their well known property of exciting a de- 
termination to the skin, are frequently combined with 
mercury in the cure of venereal blotches. Upon this 
principle I conceive to be funned many of the quack 
remedies generally employed in cutaneous affections; 
and it is for the cure of this symptom of syphilis thai 
Phmimer's pill has been most Frequently used.f 

Crude antimony is, in cases of this kind a favourite 
medicine with some practitioners, and when conjoined 
with mercury I think I have observed it prove useful 
It may be given either in powder or pills, to the ex- 
tent of fifteen or twenty grains three times a-day ; and 
besides being given along with the mercury, it may be 
continued with advantage for two or three weeks aftei 
the mercurial course is over. 

* Vide Appendix, Vol. I. No. 4. f Vide Vol. IF, No, 21 



244 OF THE CURE Ch. rv> 

} 5. Of the Cure of Nodes, Swellings of the Perioste- 
um, Sfc. 

A description of these swellings has already been 
given in Section II. page 62 ; and it is of importance 
in the method of cure to distinguish them accurately. 

In all the affections to which the periosteum and 
bones are liable from the syphilitic virus, mercury 
ought to be given immediately, for it is -upon this rem- 
edy that we chiefly depend. Where the bones are 
much swelled, that is, where tumours truly osseous 
have arrived at any great bulk, mercury alone will not 
prove sufficient ; for although it may destroy the con- 
stitutional infection, these tumours will remain, but 
when given immediately upon their first appearance, 
it will prevent their farther increase ; and as they are 
always small at first, although they may never disap- 
pear entirely, no inconvenience will be experienced 
from their remaining in this state, even during the life 
of the patient. 

The method of throwing mercury into the system 
by unction is the best adapted for this symptom, as it 
is perhaps with a very few exceptions for the cure of 
every symptom of the disease ; but it does not appear 
that any advantage is derived from rubbing the oint- 
ment upon the tumours. On the contrary, by tending 
to irritate and fret the skin, it renders them more pain- 
ful, so that it answers better to apply it to other parts. 

As the bones seldom become affected till the disease 
has been of long duration, it is perhaps for this reason 
that more mercury is in general required for the cure 
of this symptom than for any other syphilitic affection. 
1 believe, however, that we are often deceived in this, 
and continue to give mercury for the cure of the local 
affection long alter the virus by which it was produc- 
ed is eradicated, and for which purpose alone it was 
prescribed. Next to the state of the system, which 
we render safe by a due continuation of the mercurial 
course, the pain excited by the tumour is the symp- 
tom which chiefly requires attention. When the mer- 
cury is employed immediately upon the swelling tak~ 



SeC. V. OF LUES VENEREA. 245 

ing place the pain commonly subsides soon ; but if the 
tumour has previously arrived at any considerable 
bulk, the pain which it excites is apt to be severe, 
while it is not allayed or even lessened by all the mer- 
cury we can employ. Where the skin has become in- 
flamed and painful, some relief will be obtained from 
saturnine applications; but as the pain depends chiefly 
on the stretching of the periosteum by the tumour of 
the bone, whenever it becomes severe nothing will 
prove effectual but the division of this membrane. 
No practitioner would lay a bone bare for a moderate 
degree of pain, whatever the cause of it might be ; but 
whenever the pain produced by nodes becomes distress- 
ful, and is not allayed by a course of mercury, as I 
know of no other remedy that will give relief, I con- 
clude that we are fully justified in advising an incision 
to be made completely through the periosteum, along 
the whole course of the tumour. 

Where the bone is not so much increased in bulk, 
and not otherwise diseased, if a sufficient quantity of 
mercury has been given for the destruction of the vi 
rug, a cure may be obtained without any part of it ex- 
foliating. With which view the mildest dressings on- 
ly should be employed, while the sore is protected as 
effectually as possible from access to the air. But, 
when the tumour of the bone is considerable, and par- 
ticularly when caries has taken place, as it would be 
vain to expect a cure but with the exfoliation of the 
diseased parts of the bone, so all such means should 
be employed for effecting this as are known to be most 
powerful. Any of the soft parts covering the diseased 
part of the bone should be removed with escharotics. 
Small holes should be drilled through the carious part 
of the bone, and the sore should be dressed with pre- 
cipitate or verdigris ointments, of such a strength as 
to act gently as stimulants upon the contiguous parts. 
By due perseverance in this mode of treatment, and 
taking care at the same time to support the strength of 
the patient with a nourishing diet, the diseased parts 
of the bone will at last exfoliate, when the healing of 



216 OF THE CURE Cll. IV. 

the sore not being impeded by any other cause, a cure 
will soon be obtained with common treatment. 

The next variety of tumour taken notice of in the 
description which I have given of nodes, proceeds, as 
we have had occasion to see, from the effusion of a thin 
fluid between the periosteum and surface of the bone. 
This also is apt to be accompanied wilh severe pain ;» 
but as the pain is induced by the distension of the pe- 
riosteum, inconsequence of a fluid being collected be- 
neath, and as this fluid is frequently absorbed on the 
mercury taking effect, we seldom find it necessary to 
lay this variety of tumour open. Absorption of the 
matter is sometimes promoted by the application of a 
blister to the part, or by rubbing it occasionally with 
stimulants, such as volatile liniment or tincture of can- 
tharides. But when the swelling has been of long du- 
ration, as the surface of the bone is in this case com- 
monly injured, as the absorption of the matter does not 
take place so readily, and as the tumour at the end of 
the mercurial course is commonly larger than before, 
an incision the whole length of the tumour should be 
made through the periosteum, and the wound dressed 
in the manner just now advised. I think it right, how- 
ever, to observe, that the opening of these tumours is 
very seldom necessary ; and that it would in no in- 
stance perhaps be so if mercury was given in sufficient 
quantity soon after their formation. Even where the 
quantity of effused fluid is considerable, the swelling, 
for the most part begins to lessen soon after the mercu- 
ry has fully entered the system ; and if the effect of 
the medicine is kept up for a sufficient length of time 
we seldom fail in removing it entirely. 

In those diffused swellings upon the bones which I 
have taken notice of in the description as a symptom 
of syphilis, and which also have improperly been term- 
ed nodes, mercury, when properly given, seldom fails 
to effect a cure ; but it requires to be given in as large 
quantities as the patient can bear, and to be continued 
for a considerable time, commonly for nine or ten 
weeks. The pain indeed soon subsides upon the mer- 
cury taking full effect; but when the swelling has been 



SeC. V. OF LUES VENEREA. 247 

of long continuance, as often happens before mercury 
is given, from the disease being at first apt to be mis- 
taken for rheumatism, in order to remove it the mercu- 
ry must be employed for several weeks after the pain 
has ceased. In the treatment of this symptom blisters 
prove particularly useful, and they should be applied 
along the whole course of the swelling. 

Where the ligaments, tendons, and fasciae of mus- 
cles, become swelled, as sometimes happens from the 
matter of venereal ulcers spreading to those parts from 
the skin and cellular substance where they originate, 
we depend entirely upon a course of mercury, with 
proper attention to the external treatment of the ul- 
cers in the manner we have already pointed out. 

5 6. Of the Cure of Venereal Excrescences about the 

Anus. 

In section second of this chapter, a very particular 
description has been given of these excrescences. 

A full mercurial course is the remedy for these ex- 
crescences, under which they gradually lessen, and at 
last very commonly disappear altogether ; but where 
we are disappointed in this, we must use the same ap- 
plications recommended for the removal of the warty 
excrescences which succeed to Gonorrhoea. 5 * 

The disease being now entirely local, no advantage 
can accrue from mercury being longer continued, 
while we seldom fail with a proper application of es- 
charotics. 

Where the surface of these excrescences becomes 
ulcerated, and yields matter, saturnine lotions and 
other astringents should be employed to heal them : 
for as the matter which they afford appears to be ve- 
nereal, and of which we judge from the real venereal 
bubo being in women sometimes produced by it, the 
longer that this secretion is allowed to continue the 
more of it will pass into the system, and the greater 

* Vide Chapter III. Section XIII. Vol. I. 



248 or the gMe Ch. W& 

the risk will therefore be of some of the glands in its 
course towards the heart being obstructed. 



When local applications become necessary to venereal excres- 
cences, we would recommend the use of the Tincture of the Oxy- 
muriate of Iron, as stated in the note to Chap. III. Sect. XIII. — 
We have found it much preferable to the remedies mentioned by 
Mr Bell, or Mr. Hunter, or the Pulv : Sabin : so highly spoken of 
by Mr. Howard. The same remedy will be found useful in warts 
on the organs of generation. Ed. 

$ 7. Of the Cure of the Venereal Swelled Testicle. 

For the description of this affection of the testicle, 
and of the difference between it and other tumours 
to which the testis is liable, I must refer to section 
second of this chapter. 

One important difference between this tumefaction 
of the testicle and that which proceeds from Gonor- 
rhoea is, that in the latter mercury very frequently 
does harm, while in this it is the remedy upon which 
we chiefly place dependence. Unless the swelling has 
been allowed to advance to a great size, from an opin- 
ion which some have entertained that it is always of a 
local nature, and not connected with diseases of the 
constitution, mercury seldom fails to cure it. Were 
it not to add considerably to the extent of the present 
work, this, as well as many other points, of which I 
have had occasion to take particular notice, might be 
illustrated and proved by a variety of cases which have 
fallen under my observation, in which the swelling of 
the testis to which I allude, produced altogether by 
the syphilitic virus in the system, and in many instan- 
ces where Gonorrhoea never existed, after resisting ev- 
ery other remedy, has at last been completely cured 
by mercury. Besides other views of no small import- 
ance in the theory of the disease,, which this lends to 
establish, it may be looked upon as an additional argu- 
ment for considering the matter of Gonorrhoea and of 
pox as different. The swelling of the testis which oc- 
curs in Gonorrhoea vields entirely to the effects of an 



SeC. V. OF. LUES VENEREAo 249 

antiphlogistic course and without doing an injury to 
the constitution, while the other in no instance has 
been known to do so, and gives way only to that re- 
medy which we know by experience is alone to be 
trusted for the cure of every other symptom of sy- 
philis. 

Mercury even proves effectual in removing those 
tumours in- which matter has formed. I have met 
with several cases in which a partial suppuration had 
taken place in the body of the testis before mercury 
was given, and the matter has been absorbed, and the 
swelling entirely removed soon after a sufficient quan- 
tity of the medicine has been thrown in. In some I 
have thought that mercury was assisted by a decoction 
of mezereon being given along with it ; but it is for 
the most part abundantly successful by itself. 

Where the use of mercury has been too long delay- 
ed the swelling commonly suppurates, and the sore 
which ensues from the bursting of the tumour assumes 
always a very ugly appearance. Even in this situa- 
tion, however, our chief advantage is derived from 
mercury ; nor do we often fail in curing the sore if 
due attention is given to regular dressings, and pro- 
curing a free discharge of the matter. The best dress- 
ings for this purpose are the saturnine and zinc oint- 
ments when the parts are clean, and the precipitate or 
verdigris ointments when they are foul or sloughy. 

But where matter is observed to lodge in any part 
of the swelling, nothing can be of advantage but mak- 
ing a free opening into it. This, however, is not al- 
ways done so completely as it ought to be. The tes- 
tes being organs of much delicacy, we are apt to be 
afraid of opening any abscesses that may form in them, 
in consequence of which the matter is apt to find ac- 
cess into the cellular substance of the scrotum, where 
it seldom fails to produce very troublesome sinuses. 
This however, may always be prevented, either by 
making a free incision into the most depending part 
of the abscess, without allowing it to burst, or taking 
care to en'arge the opening if it has previously made 
way for itself. Nor should we ever be afraid of doing 

vol. ii. 32 



250 OF THE CURE Ch. IV. 

so, for the injury which this may do to the testicle can- 
not be equal to what it must suffer from matter being 
allowed to lodge in it. In all such circumstances I 
never hesitate to lay the testicle freely open, and no 
inconvenience ever ensues from it. 

As this affection of the testicle never occurs but in 
Tery advanced stages of syphilis, it requires a very con- 
siderable quantity of mercury to remove it, and at the 
same time to eradicate the virus from the system by 
which it has been produced. It ought to be continu- 
ed from ien to twelve weeks, and in as great quantities 
as the patient can bear. 

When the sores which ensue from the bursting or 
opening of these tumours do not heal after such a quan- 
tity of mercury is exhibited as we judge to be proper 
for the safety of the constitution, some advantages ifc 
occasionally derived from a plentiful use of hemlock, 
and from sea-bathing ; but in such circumstances no- 
thing proves for the most part so useful as dressing the 
parts in the manner I have mentioned with stimulat- 
ing ointments, and touching them occasionally with 
caustic. This we are also apt to be afraid of from the 
natural irritability of these parts ; but I have not 
found that there is cause for this. On the contrary, 
a free application of caustic to the surface of these 
sores renders them for the most part less painful. 
Where much irritation however prevails, and is not 
removed or much lessened by the use of caustic, opi- 
ates must be given in such quantities as are sufficient 
to allay it. 



The general remedy will remove this symptom, and the applica- 
tion of mercurial ointment to the part ought to be suspended until 
towards the end of the course, as it may possibly induce, a metasta 
sis, if applied at an earlier period. Ed. 

v 8. Of $he Treatment of Alopecia, Venereal Blindness ; 

and Deajness. 

A description of these symptoms wa3 given in See- 
lion II. of this chapter, § 11. 12. and 13, 



See. V. OF LUES VENEREA 3r5I 

. When alopecia, or the falling off of the hair takes 
place in any considerable degree before mercury is 
employed, particularly if the patient is advanced in 
y ars, it never grows again but in very small quanti- 
ties ; but during youth, and when mercury is given m 
the commencement of this symptom, we not only pre- 
vent it from advancing farther, but any hair that has 
been lost will very commonly be renewed. There is 
scarcely indeed any other remedy upon which we can 
depend but a full course of mercury ; for although 
many external applications are recommended to re- 
cover or renew hair lost in this manner, there is no 
reason to suppose that any advantage is derived from 
them. 

Where the falling away of the hair is connected with 
a scurf over the head, some benefit indeed is obtained 
from the application of external remedies ; by remov- 
ing the eruption we tend to prevent any farther loss of 
hair, and the internal use of mercury alone is not alto- 
gether sufficient for this. The most effectual applica- 
tions for the removal of this are the unguentum citri- 
num,* and a weak solution of corrosive sublimate in 
water. When the former is used the parts should be 
rubbed with it once a-day. The latter may be applied 
three or four times daily, in the proportion of half a 
grain of the mercury to an ounce of water ; and for the 
more effectual application of these remedies, the head 
should be shaved, and the hair not allowed to grow till 
the eruption or scurf is entirely removed. 

In the treatment of blindness as a symptom of Lues 
Venerea, we have scarcely any variety of practice. 
Mercury is perhaps the only remedy from which any 
advantage is to be expected ; nor does it prove of any 
avail if it be not given immediately, and in as great 
quantities as the patient can bear. Whether the eye is 
therefore affected with gutta serena, cataract, or effu- 
sions upon the cornea, where there is the least reason 
to suppose that the affection proceeds from Lues Ve~ 
nerea, the patient should be immediately put under a 

* Vide Appendix, No. 14. 



252 OF THE CURE Ch. IV t 

complete course of mercury, and his mouth kept fully 
affected for the space of ten, eleven, or twelve weeks, 
according to the effects which may arise from it. 

In gutta serena it may be proper before mercury is 
given to premise a smart purgative or two, and during 
the course to conjoin the repeated application of blis- 
ters to the temples and head, with electricity, and err- 
hines for the purpose of exciting a discharge by the 
nose, although the effects of these remedies are so un- 
certain that in every instance our chief dependence 
must rest upon mercury. 

Where the blindness is found to proceed from cata- 
racts, if mercury does not succeed m removing the 
opacity, our only remedy must be the usual operation 
of depressing or extracting the chrystallines. This 
will not always succeed, but where the eye is other- 
wise sound, and only the local affection of the lens ap- 
pearing to be the < ause of blindness we ought in every 
instance to advise it. 

We sometimes find that mercury here proves so far 
■useful as to lessen the opacity of the lens in a conside- 
rable degree, without removing it entirely ; and where 
this has happened I have found in more instances than 
one that a cure has been accomplished by electricity. 
I have never perceived, however, that electricity has 
produced any advantage where the opacity was not 
previously much diminished, and even in this situation 
it requires to be long continued in order to prove effec- 
tual. 

In blindness produced by the humours of the eye 
becoming confused or turbid, where it is known that 
this proceeds from the system being affected with sy- 
philis, the patient ought no doubt to be put under 
mercury ; but this cause of blindness is of a vtry hope- 
less nature, for I have never known an instance of its 
being removed. Neither do we prove very successful 
even with mercury, where vision is affected by the 
matter of syphilis fixing upon the coats of the eye. 
We may prevent the. disease from advancing much 
farther, but mercury does not appear to be sufficient 
for removing any considerable degree of opacity in the 



Sec. \. OF LUES VENEREA. 253 

cornea that has already taken place. Nor does this 
cause of blindness admit of remedy by means of a sur- 
gical operation ; for it is not upon the surface, but in 
the very substance of the cornea that it is seated. 

When abscesses form in the coats of the eye, we have 
it in our power by discharging the matter which they 
contain to remove in some degree the deformity which 
they produce, as well as the pain with which they are 
accompanied ; but we are not to look for any farther 
advantage from this or any other remedy that can be 
proposed. 

Of all the symptoms of Lues Venerea, none prove 
more obstinate, nor are less acted upon by mercury 
than deafness. A certain degree of deafness, indeed, 
produced by venereal ulceration or swelling at the 
opening of the Eustachian tube in the throat is some- 
times relieved or even removed by a course of mercu- 
ry ; but no advantage is ever obtained from this or any 
other remedy where the disease has fixed upon the 
membrane or bones of the ear. In the description of 
this symptom, I had occasion to remark, that a tempo- 
rary deafness is sometimes produced in Lues Venerea 
by the meatus externus being filled up by a scurfy 
eruption ; and in some instances, by the membrane of 
the passage becoming thickened and even ulcerated. 
In this, as in some other symptoms of the disease, we 
depend entirely on the internal use of mercury for 
removing the virus from the constitution ; but the local 
affection may remain after the system is rendered safe, 
The best remedy I have employed for this is a cau- 
tious use of bougies. Care, however, must be taken 
that they be not pushed so deep into the passage as to 
injure the tympanum ; and they ought to be formed of 
the mildest materials, as they never fail to do harm 
when they excite much irritation. 



In venereal ophthalmia, the first object should be to reduce the in- 
creased circulation in the vessels of the part, and of the system al- 
so, if necessary. Bleeding general or local, blisters and brisk 
mercurial purgatives ought to be administered. The blister should 
be kept open and the specific daily given with all possible expedi- 



254 OF THE CURE Cll. IV.. 

iion. The eye ought to be kept from the light until the inflamma- 
tion is gone, and the safest way will be to confine the patient in a 
<lark room. As a topic, tepid water applied with a sponge, or the 
Ung : Hydrarg : may be used. — (Howard.) Ed. 

$ 9. Of the Cure of some Anomalous Symptoms of Lues 

Venerea. 

In section second of this chapter, page 81, sundry 
anomalous symptoms of syphilis are enumerated which 
could not with propriety be described in any of the 
preceding sections. 

For the cure of these we depend almost entirely 
upon a full course of mercury. Scarcely any of them 
occur but in the later stages of the disease, and thev are 
very apt to recilr, if the medicine be not given in as 
large quantities as the patient can bear, and continued 
for a considerable time after they have disappeared. 
Besides this general course of treatment, some of 
these symptoms require a peculiarity of local manage- 
ment. 

The first that I have mentioned are those chops or 
clefts in the palms of the hand and soles of the feet to 
which syphilitic patients are sometimes liable. The 
best dressings that T have employed for these are the 
unguentum citrinum,* and unguentum e mercurio pre- 
cipit. rubr. f. But while these ointments are per- 
haps the best that can be applied to the chops them- 
selves, they are too irritating to admit of being appli- 
ed to the contiguous parts, which for the most part are 
red and tender, and which are best defended by the 
unguentum saturninum.J 

For the removal of that scurf and gummy matter 
which occasionally forms and becomes very trouble- 
some upon the eye-lids of syphilitic patients, I have 
found nothing answer so well as bathing them from 
time to time with a weak solution of white vitriol, and 
applying over the eye-lashes and cartilaginous border 
of the eye-lids a small portion of the calamine lini- 
ment^ or unguentum citrinum, so much reduced with 

* Vide Appendix, No. 14. f No. 27. 

1 Vide Appendix. No, 29. % No, 31. 



SeC. V. OF LUES VENEREA. 255 

axunge as to prevent it from exciting too much irrita* 
tioru 

The sores which succeed to the swellings described 
in p. 82, are frequently healed by mercury alone, but 
in some instances they resist even this and all the 
dressings we can employ. Caustic and other escha- 
rotics prove to be the best applications here, as we 
find them indeed to be in almost every variety of vene- 
real ulcer. When they do not succeed, it is for the 
most part owing to a greater degree of irritation and 
pain in*fhe sore than is consistent with the process of 
healing. In this case nothing proves so effectual as 
sufficient doses of opiates. 

When the pains mentioned in p. 83 do not give way 
to that quantity of mercury which we judge to be 
sufficient for the safety of the constitution, we some- 
times find that they may be removed by blisters appli- 
ed directly to the parts affected, and anointing them 
witli aether, anodyne balsam, or volatile liniment. 

For the removal of these pains we are often obliged 
to have recourse to opium. In sufficient doses it sel- 
dom fails by itself, but it proves more effectual in ev- 
ery variety of pain when given in the form of Dover's 
powder. Ten or twelve grains of the powder given 
at bed-time, and continued for seven or eight nights 
successively, very commonly affords effectual relief. 

The irritability, restlessness, and atrophy to which 
venereal patients are not unfrequently liable, are often 
difficult to remove, and sometimes even prove fatal. 
I have known different instances of these symptoms 
proving incurable where ulcers and other symptoms of 
the disease with which they were at first connected 
were easily removed, but where the patient by con- 
stant restlessness and anxiety, having first been deprived 
of his appetite, and afterwards of strength, was at last 
carried off, notwithstanding all the means that could 
be employed for his safety. 

I judge that these symptoms are in many instances 
altogether venereal, from observing them accompany- 
ing other well-marked symptoms of the disease, and 
from mercury being the only remedy that has any in- 



256. OF THE CURE Gh. IV, 

fluence in removing them. Even mercury will not al- 
ways succeed ; but in various instances I have known 
it prove effectual where every other remedy had pre- 
viously been tried in vain. Peruvian bark, a change 
of diet, and country air, are commonly prescribed ; 
but we may readily conclude that no material advan- 
tage can result from them if the mercurial course be 
not also continued till the virus is eradicated. 

This restless anxiety to which syphilitic patients are 
occasionally liable, is in some instances very effect- 
ually removed by opiates, while in others these reme- 
dies rather do harm. The only course that I have 
found to prove useful, is, a light, nourishing diet, a 
due continuance of mercury, and the patient, during 
the time of using it, being allowed to go daily abroad 
in a carriage when the weather is not cold or damp. 

In the use of mercury for the cure of this symptom 
the greatest nicety and care are required ; for in the 
delicacy of constitution which prevails here it con- 
stantly does harm, if not managed with much atten- 
tion. It cannot be given in large doses but with much 
risk of doing harm; nor can it be laid altogether aside 
without the disease gaining ground. If ever an alte- 
rative course of mercury, as it is termed, is proper 
for any of the symptoms in the more advanced stages 
of syphilis, it is here. By a regular exhibition of 
small doses of mercury the virus may be kept mode- 
rate till the strength of the system is so far restored by 
attention to regimen as to admit of larger quantities 
being given. 

The most frequent anomalous symptoms in this dis- 
ease is fever. It is often the effect of some evident 
symptom, such as bubo, ulcer, or node. In such ca- 
ses the cause is obvious, and the fever disappears 
along with the symptom by which it was induced. But 
where a quantity of mercury sufficient for eradicat- 
ing the disease has not been given, although all the 
symptoms for which it was employed may be remov- 
ed, yet fever will sometimes take place, and in some 
instances subsist for a considerable length of time? be= 
fore any external mark of the disease is perceived, 



SeC. Tt. OF LUES VENEREA, &C. 251 

This I know is doubted, and even denied by many ; 
but I have met with it frequently, and in some instan- 
ces distinguished in the most obvious manner. In some 
where from the history of the case the cause was evi- 
dent, the patient has been cured by an additional 
course of mercury, while in others, from no cause of 
suspicion being mentioned, the febrile symptoms re- 
sisted all the usual remedies, and were not removed at 
last till the appearance of nodes, ulcers, or some other 
local symptom has pointed out the necessity of a far- 
ther prosecution of mercury. 

The effect of mercury upon this fever is often re- 
markable. In almost ever^ other situation it is one 
of the first effects of mercury in a certain degree to 
accelerate the circulation of the blood, while here it 
not only lessens the quickness of pulse, but abates 
every other febrile symptom. Even in small quantities 
mercury proves useful here, as it evidently does in the 
symptom last mentioned; and as the strength of the 
patient is commonly much exhausted before this rem- 
edy is employed it should not at first be given in lar- 
ger quantities than is merely necessary for mitigating 
the symptoms. This, however, not being sufficient 
to render the constitution safe against future returns 
of the disease, care should be taken that a sufficient 
quantity of the medicine is exhibited as soon as the 
patient's strength, restored by a nourishing diet, ena« 
bles him to bear it. 



SECT. VI. 

Of Lues Venerea in Infants. 

NO period of life is exempted from the ravages of 
the venereal disease. They are frequently to be de- 
plored even in infancy, and here the same symptoms 
appear as in a patient of more advanced years ; that 
is, when the virus enters the system in the usual way 
from the surface of the body, the symptoms which 

yol.il 33 



258 OF LUES VENEREA 6h. 5V, 

ensue are nearly or entirely the same as in other peri- 
ods of life : but when the disorder is communicated to 
the foetus in utero, some variety is observed which de- 
mand particular notice. 

We have already indeed had occasion to remark, 
that it has been doubted whether Lues Venerea can be 
communicated to the fcetus in utero. Nay, of late it 
has been asserted that it cannot, and that practitioners 
upon this very important point have hitherto been mis- 
taken. But this is so contrary to general experience, 
and to the result of my own observation, that I cannot 
consider it as an opinion that will ever gain ground 
where the judgment is not entirely warped. A desire 
to support a particular theory seems to have laid the 
foundation of this doctrine ; but the facts which mili- 
tate against it are too strong and too numerous to ad- 
mit of being easily set aside. 1 * 

Those who are of opinion that neither the blood nor 
am of the secretions of a syphilitic patient can commu- 
nicate the contagion, al ledge, that when a child appears 
to have been infected in utero, the infection must have 
been communicated during labour from venereal sores 
in the genitals of the mother. 

That this in some instances happens there is no rea- 
son to doubt. A child passing over, and perhaps rest- 
ing for a considerable time upon sores of this kind, 
may readily be infected in this manner, and this may 
probably be the case in most of those instances where 
the disease does not appear till two or three weeks af- 
ter birth. But where a child is instantly upon delivery 
found to be covered with a venereal eruption, and 
which I have met with in various instances, the infec- 
tion must necessarily have been communicated a con- 
siderable time before birth. It may be asked, however, 
in what manner eruptions appearing on the birth of a 
child have been known to be venereal ? In answer I 

* Even Mr. Hunter has unguardedly fallen into -this error ; and as his au- 
thority would necessarily have influence with those whose opportunities fox- 
observation are not so great, I think it right, in a matter of such practical inx- 3 
. portance to endeavour to render the mistake obvious : see different parts e€ I 

Miv Hunter's Treatise, 



Sec. VI. IN INFANTS. 259 

may observe, that it has been ascertained in the most 
obvious manner, by finding on enquiry that the father 
had been poxed without taking such a quantity of 
mercury as was necessary to eradicate the virus : by 
the eruption upon the child being exactly similar to 
what experience in other instances shews to be venereal ; 
by a child in this situation giving the different symp- 
toms of Lues Yenerea, evidently and strongly marked, 
to the nurse by whom it has been suckled ; by the 
nurse giving the disease in the first place to another 
child, and afterwards to her husband, and by the dis- 
ease in al! of them being cured by a proper use of mer- 
cury alone, while no other remedy is of any avail. 

Every practitioner must have met with instances of 
this. I have seen many, in some of which no external 
mark of the disease appeared either in the father or 
mother, although one or other of them, and in some 
cases both, must have been infected. I conclude that 
we have sufficient evidence of this where the same pa- 
rents produce one, two, or more pocky children, and 
continue to do so till both pass through a complete 
course of mercury ; and hence, notwithstanding any 
theoretical opinion that may be advanced to the con- 
trary, I have much reason to imagine that the opinion 
which J have elsewhere given, that the semen of a dis- 
eased parent will give a pocky offspring is well found- 
ed. No person, I believe, will doubt of other diseases 
being communicated in this manner. We have daily 
proofs of it in gout, phthisis, scrophula, and, perhaps, 
in some others, in which these diseases descend from 
fathers to their children, while no infection is commu- 
nicated to the mother ; and I have met with very deci- 
sive evidence of it in Lues Yenerea, at least with such 
as leaves no room with me for doubt. 

About ten years ago I was desired to visit a child 
seven or eight days old. It was covered with a rash, 
which had much the appearance of being venereal ; 
and finding that the only other child which the parents 
ever had was born with a similar rash, of which it died, 
I enquired of the father of the child whether there was 
any cause to suspect that he was infected or not. fife* 



£60 OF T.UES VENEREA Ch. IV, 

informed me that be bad been poxed about six months 
before his marriage • that his symptoms were chancres 
and a sore throat ; but that having taken as much mer- 
cury as was judged to be sufficient, the symptoms 
having disappeared while under the course, and none 
of them having ever occurred again, although he had 
now been married nearly three years, he could not 
possibly believe that the child was infected with this 
disease, particularly as no symptom had appeared upon 
his wife. I was clearly of opinion, however, that the 
child was infected ; and I judged it right to say, not 
only that the child should instantly get mercury, but 
that he and his wife should also take it, with a view to 
prevent the same occurrence with any other children 
which they might have, as well as to render themselves 
safe. He agreed to this with respect to himself, but 
on account of the suspicion which it might create, he 
would by no means consent that it should be given to 
his wife. Imperfect as this measure might be I was 
obliged to. adopt it. Small doses of calomel were given 
to the child, and the father was kept under a complete 
course of mercury, with unction and the blue mercu- 
rial pill, for the space of ten weeks. The child got 
well ; and although the same parents have had several 
other children since that period, all of them have been 
perfectly sound. Some doubt, however, might still 
have remained of the real nature of this rash, but it 
happened that a very decisive, although unfortunate 
proof was given of its being venereal. Two nurses 
were infected by the suckling of this child. The first 
became so much distressed with ulcers upon her nipples, 
and pains in one of the mammae, that she was obliged 
to leave the family, and although warned of her situa- 
tion, and of the necessity of giving no suck to other 
children till the course of mercury which she was put 
under was finished, she foolishly took home her own 
child, which she had previously given out, and in the 
course of two or three weeks he a'so was poxed, and 
being a weakly child, he soon died, although the great- 
est care was taken of him. The nipples of the other 
nurse ulcerated, and she was soon thereafter seized 



SeC. VI. IN INFANTS. 261 

with a venereal ulcer in the throat, for which a course 
of mercury became necessary. Since that period, be- 
sides some instances in which the disease was given to 
children, where there was much reason to think that 
both parents were infected, I have met with two other 
cases very similar to that which I have mentioned, in 
which a mercurial course given to the father proved so 
completely successful that all the children of both fa- 
milies that have been born since that time have been 
entirely healthy, although one of them had previously 
lost two and the other one from their not having en- 
tertained any suspicion of the nature of the disease. 

These, as well as various other facts which I might 
adduce, render it obvious to me that Lues Venerea 
may be, and frequently is, communicated in the man- 
ner I have mentioned ; that is, by the infection passing 
directly from parents to children, and where no marks 
of disease appear either upon father or mother. Nor 
would I have judged it necessary to have entered so 
fully into the subject, as by many the opinion I am 
endeavouring to establish will be admitted, had it not 
been with a view to put the younger part of the pro- 
fession upon their guard, till by experience they are 
enabled to judge for themselves of the distressful con- 
sequences that would frequently result from the oppo- 
site doctrine being admitted. 

Among other baneful effects of syphilis, perhaps 
none prove more distressful than the frequent abor- 
tions which it evidently occasions. A child infected, 
in the uterus will in some instances not come away till 
the full time ; but in a great proportion of cases abor- 
tion takes place in the sixth or seventh month, some- 
times sooner, but most frequently about the middle of 
the seventh month. Of this I have met with such a 
number of instances, that 1 am induced to consider it 
as one of the most frequent causes of abortion ; but as 
the child is commonly either born dead, or so weakly 
that it soon dies, sufficient evidence is not often obtain- 
ed to lead the attendants to entertain any suspicion. 
Hence practitioners seldom *<< ar of it unless the disease 
has made greater progress loan usual. We have it in 



262 OF LUES VENEREA Ch. IV. 

our power, however, when this cause of abortion is 
discovered, to remove it with much certainty. A well 
conducted course of mercury very seldom fails to 
prove effectual. I have now met with a considerable 
number of instances where abortion had regularly ta- 
ken place in the sixth, seventh, or eighth month, and 
in which, from there being no mark of disease either 
upon the father or mother, the real cause of it remain- 
ed concealed ; but which being at last discovered, ei- 
ther by some of the children being clearly marked with 
the disease, or from its breaking out in an obvious 
form on one or both of the parents, a mercurial course 
has at last been prescribed, and in no instance has it 
failed where a sufficient quantity of the medicine has 
been given. In two instances it did not answer so 
completely as in the others, but in both there was suf- 
ficient evidence of too little mercury having been em- 
ployed ; for the children in both instances were kept 
till the beginning of the ninth month, which in the one 
was two months, and in the other six weeks later than 
had been the case before, and both the parents having 
in each of these instances been made to take mercury 
agam, and in greater quantities than before, no abor- 
tion has since taken place, and each family has within 
these few yeais had several healthy children. 

At whatever period children with this infection are 
born they are remarkably weak and delicate. The 
muscles over the whole body are flaccid, and the joints 
have not that firmness which they ought to possess. 
"When the disease is discovered immediately upon the 
birth of the child, it is usually in the form of an ery- 
sipelatous efflorescence over the whole body. In some 
instances the cuticle is either altogether or in part de- 
stroyed, and the skin is tender, and affords a kind of 
matter. In others the nails have not formed either on 
the fingers or toes. 

Sometimes again no mark of disease will be per- 
ceived till the tenth, twelfth, or even fourteenth day 
after delivery ; and in such cases the eruption occurs 
chiefly about the anus, on the nates, and about the 
pudendum. In these places irregular blotches aris^ 



Sec. TI. IN INFANTS. 263 

of a light strawberry colour, and somewhat elevated 
above the contiguous surface. Although a thin acrid 
serum in some instances oozes from them, if not pre- 
vented by a timeous exhibition of mercury, the dis- 
ease is apt to spread quickly over the whole body; but 
excepting in the parts which I have mentioned, it usu- 
ally appears in the form of a crusty eruption, which 
in some cases is dry, and falls off in small scales, while 
in others it is kept together by the exudation of a vis- 
cid matter, particularly upon the forehead, eye-lids ? 
arms, and breast. 

I have already had occasion to observe, that in sup- 
porting a favourite theory some have denied that the 
fetus in utero ever receives this disease from the par- 
ents, and assert, that wherever it occurs in new born 
children they must have received it from the mother in 
the time of delivery. But while the fallacy of this 
opinion is rendered obvious, as we have just had occa- 
sion to observe from the foetus being in many instances 
perceived directly alter birth to be covered with a ve- 
nereal efflorescence, we also find that the syphilitic 
Virus is in this state of a more deleterious nature than 
it ever appears to be in any other form of the disease. 
Besides, being more particularly apt to communicate 
the infection, it proceeds with more rapidity to destroy 
the constitution, insomuch, that if mercury be not 
employed immediately on the disease being perceived, 
it usually makes such quick progress that a fatal termi- 
nation can scarcely be afterwards prevented. 

In all such circumstances the child ought to be nurs- 
ed by the mother ; and as mercury is necessary for 
both, they should both be put immediately under it. 
As it has been found that a diseased child may be cur- 
ed by sucking the milk of a woman undei mercury, 
some have advised that new-born children should al- 
ways be treated in this manner. But I can say from 
experience, that it is not to be trusted. In some in- 
stances this practice will no doubt succeed. In all it 
will perhaps accomplish a temporary removal of the 
symptoms, but for the most part they return again, or 
the disease breaks out in some other form. At the 



264 OF T.tJES VENEREA Ch. IV, 

same time, therefore, that the mother begins to take 
mercury, it ought to be given to the ehild, and it may 
be done with, no ineonveniency ; for even at this early 
period it excites less distress than it usual h does after- 
wards. The rause of this may be difficult to assign ; 
bu» I have in various instances found that mercury in 
early infancy, is not so apt to excite either salivation 
or violent effects upon the stomach and bowels as it af- 
terwards does, and that it may be given with safety in 
sufficient quantities for curing the disease. Calomel is 
often employed for this purpose. The dose should be 
the fourth or fifth part of a grain three times a^day, and 
when rubbed with a small quantity of sugar, the child 
takes h easily. Mercurius alkalisatus is a preparation 
that answers particularly well in the dose of half a grain 
three times a-day ; and I sometimes employ the com- 
mon blue pill prepared with triturated quick-silver. A 
pill containing a grain of mercury, being rubbed into 
a powder, and divided into four, one of these is given 
evening and morning. Any of these being continued 
for the space of a month, will, in most instances, re- 
move every appearance of the disease ; but a com- 
plete cure will not be accomplished if the use of the 
medicine is not persisted in for a considerable time 
thereafter. When the child is healthy, and not of a 
delicate form, this should be done with no interrup- 
tion, otherwise it may be laid aside occasionally for 
eight or ten days together; but upon the whole, it 
should be giv^n for the space of fifteen or sixteen 
weeks, and never discontinued so long at once as to al- 
low the effects of the mercury upon the system to be 
entirely gone at any one time. 

When a child in this situation cannot be suckled by 
its mother, either from her want of milk or any other 
cause, what are we to do ? Another nurse is common- 
ly procured ; but this resource ought never to be 
adopted, for it seldom fails of giving the disease in the 
most virulent form to whoever is so unfortunate as to 
be employed for this purpose. All such children 
ought to be nourished and brought up on spoon meat, 
uor should the restriction be confined to the first weeks 



fteC. VT. IN INFANTS. 26^ 

of infancy only. No child infected in this manner 
should be put to the breast of a sound nurse till a 
course of mercury has been continued for three months 
at least after every external mark of the disease is 
gone. In one instance, where a child in this situation 
bad for seven weeks been nursed by the mother, and 
where mercury had been regularly continued for the 
space of three weeks after every external mark of the 
disease had disappeared two different nurses were in- 
fected, who were employed to suckle the child during 
a temporary fever with which the mother was attacked, 
And in another the disease was given in the same man- 
ner wher.e the child was three months old, and where 
every symptom of syphilis had disappeared upwards 
of eight weeks. Hence I conclude that the greatest 
attention is required for preventing similar occurren- 
ces, and that nothing will prove effectual but a regu- 
lar and long-continued use of mercury. 

In addition to what I have already said on the sub 
ject of syphilis producing abortion, I may observe, 
that when a woman has suffered one or more abortions, 
and has reason to think that they proceed from vene- 
real infection, she, as well as he4* husband, should 
immediately be put under mercury. It is a prevailing 
opinion that mercury is apt to occasion abortion, and 
it is therefore seldom given during pregnancy. Much 
experience, however, has convinced me that this opin- 
ion is not well founded, and, when managed with cau- 
tion, that it may be given in sufficient quantities at 
every period of pregnancy, for curing every symptom 
of syphilis, and without doing the least injury either 
to the mother or child. We would not indeed from 
choice give mercury during pregnancy ; but when a 
woman in this state is evidently poxed, or when there 
is good reason to think that she is .so, I vyould not hesi- 
tate to advise a course of mercury. In different in- 
stances I have done so, and always with much advan- 
tage. Where obvious symptoms of Lues Venerea 
break out during pregnancy scarcely any will doubt of 
the necessity of giving mercury, but some explanation 

vol, it. 34 



266 OF LUES VENEREA Cll. IV. 

may be required for advising it to be given where there 
is only ground of suspicion. 

In illustration of the propriety of (his, the follow- 
ing, among several cases, may be recited. Five years 
ago J visited a lady in the fourth month of pregnancy, 
on account of a simple fracture of the os humeri. The 
patient being young and healthy I prognosticated a 
speedy cure. She had been married four years, and 
bad suffered two abortions, one in the sixth, the 
other in the seventh month, and her friends were anx- 
ious lest this accident should produce the loss of an- 
other child. This induced me to enquire into the cir- 
cumstances attending the previous abortions, when I 
found that both children were born dead, and entirely 
destitute of nails and cuticle. No obvious symptom 
of syphilis had appeared upon the parents, but the 
husband had occasionally been attacked with a dry 
scaly eruption upon the breast and shoulders. I also 
discovered that he laboured under the venereal disease 
a few months before marriage; and it did not appear 
to me that he had taken mercury either with the regu- 
larity or to the extent necessary for removing the 
symptoms which took place. This led mc at once to 
say that both he and his wife should immediately un- 
dergo a complete course of mercury. To this they 
submitted, and in less than a year from the commence 
merit of the course the latter was delivered of a heal- 
thy child. Now here was only ground for suspicion ; 
but the event gave cause to imagine that if this kind of 
proof was to be set asJde where direct evidence cannot 
be procured, and which often happens in cases of this 
kind, many constitutions would be irreparably injur- 
ed, and many children lost which otherwise might be 
say eel. 

During pregnancy mercury ought in every instance 
to be used in the form of unction, as we thereby with 
most certainty prevent it from acting upon the stom- 
ach and bowels, and thus avoid the hazard of abortion 
taking place as the effect of irritation upon these parts. 

.Nothing indeed more readily excites abortion than 
purgatives^ when severe in their operation upon the^ 



Sec. VI. IN INFANTS. 26? 

bowels, or when they even only produce any consid] 
erable degree of tenesmus ; and as the internal exhi- 
bition of mercury is frequently the cause of this, it can- 
not but with much hazard be given in any considera- 
ble quantity during pregnancy. 



Among the peculiar opinions entertained by Mr. John Hunter,, 
on the Venereal Disease, those relating to the communication of 
the infection to new-born infants, are not the least singular. He 
maintained that the child while in the womb cannot be affected with 
syphilis by either parent, that after birth it cannot be diseased by 
sucking an infected nurse, and also that if it have received the con= 
tagion in passing through the vagina, it cannot transmit the disease 
to the nipples of the nurse. Contrary tenets are upheld by our au- 
thor, and we believe by a large majority of the Medical Profession. 
The question is however far from being decided, and as Mr. Bell 
has stated the important arguments in favour ol the idea that the 
disease may be communicated in utero, we will now add what are 
advanced against it. It is urged in the first place, that parents de- 
cidedly infected, often produce children wiio are bora and continue 
perfectly healthy. This is allowed by the opposite party and par- 
ticularly by a late writer, (Mahon on the existence, nature and com= 
munication of venereal infection in pregnant women, new-born in- 
fants and nurses,) as is also the fact that the symptoms as detailed 
by Mr. Bell, wili often appear on children soon after birth, in whose 
parents, no symptoms of syphilis have existed for years. To both 
these, it is however replied, that the venereal poison may lurk for a 
length of time in tne constitution of the infant or parents, before it 
discovers itself, an observation of but little weight, since it is evi- 
dent that there must be a general contamination of the secretions s 
in order to affect the offspring. The Editors of the London Annual 
Medical Register remark, that they have seen children born of del- 
icate and sickly mothers, attacked with a disease resembling that 
described by Mr. Hunter, and tiiey have been much pleased to find 
it described by Dr. WLlan under the name of Pemfihigus Infantilis, 
The symptoms, they add, are very similar to those named by Ma- 
hon as distinctive of lues in new-born infants. An aphthous state 
of the mouth and fauces, although not named by Wiliao, is a com- 
mon attendant, and the aphthous discharge deposited on the nipples 
of the nurse might produce a train of symptoms resembling syphi- 
lis. Many points in this important subject, require elucidation, and 
we hope they will claim the attention of those who have had exten» 
sive experience in hospital practice, Ep, 



2bB OF LUES VENEREA IN Ch. IV 



SECT, VII. 

Of some Peculiarities of Form under which Lues Venerea 
has appeared in Scotland and Canada. 

I HAVE already bad occasion to remark that this 
disease has appeared with some peculiarities both in 
Scotland and in Canada. By the accounts received of 
it from Canada it seems to have appeared in that coun- 
try in the same manner, and under the same form as it 
had a considerable time before done in Scotland ; and 
as few have had more opportunities of seeing it here 
than I have had, I mean to give a short description of 
the appearances which it exhibits, and to mention the 
method of cure which hitherto has been found most ef- 
fectual. 

In the Highlands of Scotland this disease is usually 
termed sivvens or sibbens : In Dumfries shire and Gal- 
loway it is commonly called the yaws, from a resem- 
blance which it is supposed to bear to the African and 
West Indian disease of that name ; but over the whole 
kingdom it is known to be the venereal disease. That 
this is so is certain from those afflicted with it in every 
district where it has yet appeared having been able to 
trace it to such an origin as left no room for doubt, as 
well as from the symptoms which take place in it bear- 
ing an exact resemblance to those; of the later stages of 
Lues Venerea in the ordinary form of the disease, and 
from mercury being the only remedy upon which we 
can place any dependence for a radical cure. 

It never appears, as I have elsewhere had occasion 
to observe, in the form of Gonorrhoea, nor seldom at 
first in any form upon the genitals, owing to the man- 
ner in which it is most frequently communicated. The 
infection being for the most part received by eating or 
drinking out of the same utensils with those labouring 
under the disease, it often appears at first in the; 
throat or some part of the mouth. In the mouth the 
sores have the usual appearances of venereal ulcere 
This is likewise the ease in the throat when the disease 



SeC. VII. SCOTLAND AND CANADA, 269 

has been of some duration; but at first, and often for 
the space of several weeks, although the patient com- 
plains of a good deal of uneasiness in swallowing, and 
of a constant hoarseness, there is nothing perceived 
upon inspection but a degree of tenderness accompa- 
nied with an erysipelatous redness of the amygdala?, 
uvula, and velum pendulum palati. If not prevented, 
however, by the use of mercury, ulcers at last form 
upon these parts, and commonly spread more quickly 
than venereal ulcers usually do in other parts of th£ 
body ; insomuch that the uvula and amygdala? will 
sometimes be entirely destroyed in the course of a few 
days, and a degree of hoarseness and loss of voice 
produced, from which the patient never afterwards re- 
covers. 

It is particularly apt to affect the internal parts of' 
the nose ; and when the sores penetrate to the ossa 
spongiosa these soon become carious, and come away 
in small pieces along with the matter, which is always 
exceedingly foetid. When not prevented by mercury 
the ulcers spread to the hard bones of the nose, and 
from these to the bones of the cheeks. In this manner 
the whole face becomes ulcerated, for when these 
bones are affected the contiguous soft parts likewise, 
become soon diseased. It is not uncommon for these 
ulcers to attack the eye-lids. 

When the infection is not received by the mouth 
the disease appears in a variety of forms in different 
parts of the surface of the body. When the virus has 
entered the system the parts upon which it first com- 
monly breaks out are the genitals, the parts contigu- 
ous to the anus, the anterior parts of the thighs and 
legs, the under part of the abdomen, the breast, arms, 
fingers, and toes, and hairy scalp. It does not so 
readily fix upon the fleshy parts of the legs or thighs, 
or on the back. In some the parts become covered 
with an infinite number of small pustules, and, as they 
are itchy, the disease is at first often mistaken for itcb.. 
This happens the more readily from its prevailing al 
most entirely among the common people, who, ftom 
want of cleanliness, frequently labour under itch ; and 



270 OF LUES VEltfEREA IN (Jh. IV 

so much is sibbens confined to this set of people, thai, 
excepting children, who are more particularly exposed 
to receive infection from servants, those in the higher 
ranks of life are scarcely ever attacked with it, at least 
few instances of their being so have fallen within my 
observation. 

This eruption, however, soon assumes appearances 
which sufficiently distinguish it from itch. The skin 
upon which it is seated becomes thickened and 
somewhat elevated, and acquires the characteristic 
mark of venereal blotches, a peculiar copper-colour 
appearance. 

The late Doctor Gilchrist of Dumfries, in a paper 
upon this subject, in the Physical and Literary Essays 
of Edinburgh, remarks, "that these scabby eruptions 
are often met with on the scalp, forehead, inside of the 
thighs, groins, and parts contiguous. Inflammation 
and excrescences about the fundament are frequent ; 
and it sometimes appears in the form of a herpes exe- 
dens, healing in one part and breaking out in another." 

Some have small tubercles, or hard elevated knots 
upon the face, arms, and breast, somewhat resembling 
small pox at the height, but of a red or copper-colour, 
and accompanied with a painful degree of heat, if 
mercury is given early these tumours gradually subside, 
otherwise they become large and discharge a foetid vis- 
cid matter, which forms into crusts or flakes, and on 
their falling off, the parts beneath are red, tender, and 
in some cases in a state of ulceration. 

Instead of this more numerous eruption, some are«.at- 
tacked with small inflammatory boils, which do not 
readily suppurate, but remain for a considerable time 
hard and of a copper-colour, and at last discharge a 
thin bloody ichor. These at first resemble the com- 
mon anthrax or carbuncle, but soon after bursting they 
assume all the appearances of the true venereal ulcer. 

But the most characteristic symptom of this variety 
of syphilis is a soft spongy excrescence, in size and 
colour resembling a common rasp, which is apt to ap- 
pear on all such parts as either become ulcerated, or 
that are attacked with any kind of eruption § sivven or 



SeC. VII. SCOTLAND AND CANADA. 27 i 

sibben being in many parts of the Highlands the name 
of a wild rasp, and this being a very frequent symptom 
of the disease, is the cause of its being distinguished 
by this appellation. In some instances this spongy 
substance rises to a considerable height, nor can it be 
kept down by any of the common escharotics ; for al- 
though entirely removed, if the virus of the disease be 
not eradicated by the use of a full course of mercury, 
it soon returns to a greater extent than before; but as 
mercury is commonly given as soon as this symptom 
becomes evidently marked, the excrescence is seldom 
so much elevated as it otherwise would be. 

These fungous productions are occasionally met 
with in every part of the body ; but they are particu- 
larly apt to form on such parts as have become tender 
whether from previous eruption or from the cuticle 
having separated and come off from the skin beneath ; 
a circumstance which sometimes takes place in this dis 
ease, and when to any considerable extent, always: 
with much inconvenience and distress. 

In the treatise which I have mentioned, Doctor Gil- 
christ observes that this disease does not attack the 
large and solid bones, and very rarely any of the 
others. I have however seen several instances of the 
contrary, in which both the bones of the legs and 
arms have been affected ; and it is by no means un* 
common to find this disease fix upon the bones of the 
head. I have seen it indeed in every part of the body, 
and in every form under whi ch Lues Venerea usually 
appears, except in chancres upon the genitals. I have 
seen it produce sores resembling chancres upon the 
lips and on the nipples of nurses ; and where an infec- 
tion has been of long duration I have known ulcers 
form upon the penis, but I have not known an instance 
of its producing chancres either in men or women 
from coition, owing, I imagine, to all who are attacked 
with ulcers upon these parts from this cause avoiding 
venereal intercourses, which they very universally do 
till a cure is obtaned bv a course of mercury ; but al~ 
though sibbens is not usually met with in the form of 
chancres upon the penis, this, as well as other parts of 



272 OF LUES VENEREA IN Cb. IV, 

Ihe genitals, are particularly apt to be attacked with 
such ulcers as appear from the virus having entered 
the constitution. In different instances I have known 
the whole penis and scrotum destroyed with it, but this 
has commonly happened from the patient having neg- 
lected too long to call for medical assistance, or from 
mercury being given in too small quantities. 

These ulcers, like the usual form of venereal ulcers 
proceeding from the constitutional form of the disease, 
do not commonly produce buboes. This, however, is 
siot universal ; for buboes sometimes take place in sib- 
bens, not only from the primary ulcers of the disease, 
as I have in more than one instance perceived in the 
arm-pit from sores produced upon the nipple in nursing 
an infected child, but also from those which appear 
upon the penis and other pads of the genitals from the 
virus having entered the system, and the appearance of 
buboes produced by sibbens, whether in their swelled 
or ulcerated states, is in every respect the same with 
that of the ordinary form of venereal bubo. 

Syphilis, in whatever way the infection is communi- 
cated, is readily transmitted, as we have already had 
occasion to see, from parents to the foetus in utero, and 
this is particularly apt to happen in sibbens. Sibbens 
therefore proves a frequent cause of abortions, al- 
though in some instances children are born with it at 
the full time, and in a few it breaks out in the course 
of the first month after delivery. 

In the treatment of sibbens, as of every variety of 
Lues Venerea, mercury is the only remedy upon which 
we can place dependence. Sarsaparilla, guiacum, and 
inezereon have occasionally proved useful, but we 
trust to mercury alone for a radical cure. The obser- 
vations we have already had occasion to offer on the 
employment of mercury apply with equal propriety to 
the treatment of every symptom of sibbens. It is 
therefore unnecessary to consider the subject farther at 
present; but while we refer for this purpose to differ- 
ent parts of the preceding sections, I think it right to 
observe, that a greater quantity of mercury is in most 
Instances required for the cure of sibbens than we usu- 



SeC. VII. SCOTLAND AND CANADA, 273 

ally find to be necessary in the ordinary form of the 
disease. Relief is obtained with perhaps equal ease, 
and a stop may be put to the farther progress of the 
disease by the same quantity that we employ for the 
common symptoms of pox, but it is more apt to return 
if the medicine be not given in larger quantities, and 
continued for a considerable time after every appear- 
ance of infection is removed. When the disease has 
been of long duration mercury ought to be continued 
for seven or eight weeks after every symptom has dis- 
appeared. 

A practitioner of experience and observation, and 
who had many opportunities of seeing every symptom 
of sibbens, informed me that mercurius sublimatus 
corrosivus frequently proves successful in the cure of 
the more inveterate symptoms of the disease when the 
milder preparations of mercury fail. He gave it in 
the form of drops. Sixteen grains were dissolved in 
an ounce of water with the addition of eight grains of 
crude sal ammoniac, and of this ten drops were given 
three or four times a-day. 

When ulcers in the throat and other parts do not 
readily yield to the use of mercury, vve have recourse 
to caustic and escbarotics, and they prove equally 
useful here as in every variety of sore proceeding front 
Lues Venerea. In various instances they have been 
rendered, clean and brought into a healing condition 
by fumigating with cinnabar, when they had previous- 
ly resisted every other remedy. 

The public, however, are equally interested in the 
prevention of this disease as in the cure of it, particu- 
larly in those districts where it has long prevailed, and 
with proper attention there is much reason to suppose 
that it might soon be eradicated. In some parts of 
Scotland this has already indeed been accomplished., 
and the means by which it has been done are simple* 
and easily practised. They consist entirely in a due 
attention to cleanliness and in preventing nurses and 
other servants from being employed where there is the 
least reason to imagine that they are infected. In the 
choice of a nurse this is a point of the utmost import 

"VOL. II* M 



27 <1 OF LUES VENEREA IN Ch. IV 

ance ; for in sibbens, as in every other form of syphi- 
lis, I have had many proofs of the disease being com- 
municated by the milk alone, and as this is almost 
the only way by which it has found access to families- 
of rank, they are particularly interested in prevent- 
ing it. 

The chief difficulty which occurs to the prevention 
of this disease proceeds from those who ought most 
anxiously to wish for it. The infected are so much 
afraid of a discovery being made to injure their repu- 
tation that they do all in their power to conceal it, by 
which they are often prevented from taking mercury 
in that complete manner by which alone a cure can be 
accomplished, I know, however, that this anxiety for 
concealment may be removed, and, with proper atten- 
ion, that those poor people who otherwise would fall- 
victims to the baneful effects of the disease may be 
easily induced to apply for medical assistance. The 
clergy have this so much in their power, that through 
their interference the sibbens might soon be eradicat- 
ed. In one parish this was actually done. The dis- 
ease had spread to such an alarming height that more 
than three-fourths of the inhabitants were infected, and 
many of the more delicate, particularly young chil- 
dren and females, died under it. This had gone on 
for many years, when by the exertions of the clergy- 
man of the parish it was entirely removed in the 
course of a short time. He went personally to every 
individual of his parish and convinced them of the 
propriety of applying for medical assistance immedi- 
ately on the disease breaking out, which they agreed 
to the more readily from their being sensible that' all 
of them had got the disease in the most innocent man- 
ner. In this way it was soon carried off, and by due 
attention to cleanliness, and avoiding all kind of in- 
tercourse with those who they suspected to labour un- 
der it, the disease has now for a considerable time 
been entirely subdued. This has in some degree in- 
deed been the case in every district of Scotland where 
sibbens ever prevailed. In some situations it has been; 
nearly eradicated, and in none is it now so frequent 



Sec. VII. SCOTLAND AND CANADA. 275 

as it was some years ago. There is much cause there- 
fore to hope that by the superior attention to cleanli- 
ness, which of late years has prevailed among our 
common people, it will soon become every where un- 
known. 

If the disease as it prevails in Canada is the same 
with the sibbens of Scotland, and from all that I have 
heard of it there is no cause to doubt of its being so, 
the same method of cure will prove effectual, and the 
same means of prevention must be observed. 



The first account of Sivvensor Sibbens was published in 1771, by 
Dr. Ebenezer Gilchrist, of Dumfries, in the third volume of " Es- 
says and Observations, Physical and Literary, by a Society in Edin- 
burgh." This Essay was however read in 1765, and printed during 
the same year for general distribution. In 1767, an Inaugural Dis- 
sertation De Syfihilitide -venerea was published at Edinburgh by Dr. 
Adam Freer, to which was added an appendix on Sivvens, and in 
1772, Mr. James Hill, Surgeon in Dumfries, published an account 
of the same disease in which he controverted several of the opinions 
maintained by the former writer. If, in addition to these are men- 
tioned the notices of our Author and Dr. Swediaur in their works 
on the Venereal Disease, a Paper by Dr. Paterson of Air, in Dr 
Beddoes' " Contributions to Medical Knowledge," an Inaugural 
Dissertation Be Syfihilitide Insontium, published at Edinburgh, in 
1S05, by Dr. M'Leod, together with a Chapter in Dr. Joseph 
Adams's work on Morbid Poisons, 2nd Edition, 1807, they will 
comprehend, we believe, the whole of the literary history of this 
remarkable disease. 

Dr. Gilchrist's descriptian -of Sivvens as quoted by Dr. Adams, 
is similar in every material point to the account given by our author. 
In Dr. Freehs Dissertation, a most whimsical opinion is introduced 
concerning its origin. Supposing Syphilis to arise from an insect 
and adducing the authority of Mead that the itch also originates 
from one, " the author suggests the probability that coitkn of the 
" male and syphilitic insect with the female itch insect, may have pro- 
" duced an hybrid race of animals, the cause of sivvens." Imperfect 
as his description of the disease is, says Dr. Adams, we may col- 
lect from it the following facts. That it was frequently spread by 
smoaking with the same pipe— that it is more easily cured by mer- 
cury than syphilis — and that some women have been permanently 
cured, without the use of any remedy, during the alteration that 
their constitutions have undergone in gestation or parturition. — - 
(Adams on Morbid Poisons, 2nd Edit. p. 179.) 

Mr. Hill states that the Sibbens was brought into the Highlands 
of Scotland not by Cromwell's men, but by diseased soldiers aboui; 
fifty years preceding the time at which he wrote. He considers i* 



276 OF LUES VENEREA IN Cll. IV. 

the same disease as syphilis, and in proof of its not being peculiar 
to Scotland, adduces extracts from various standard writers giving 
an account of Lues, communicated in the same way and exhibiting 
similar symptoms, which in general are those stiled secondary. He 
further states that the disease is not more infectious, as he is unac- 
quainted with any instance where it was communicated except thro* 
an abraded skin, and by sweat or exhalation. Allowing the truth 
of the fact as stated by Dr. Freer, that sivvens may be more easily 
cured by mercury than syphilis, he attributes this to the temper- 
ance, vegetable diet and healthy constitutions of the inhabitants, but 
adds that he has observed cases, in which the disease remained even 
after salivation, particularly in the throat. This latter affection says 
Mr. Hill, is a consequence of an universal taint of the blood, if the 
disease is not communicated by the mouth, but where the infection 
is given by afoul spoon or pipe, the angles of the mouth, the lips, 
gums, Sec. are first affected with ulcers, resembling a piece of white 
soft velvet, which gradually becomes broader and deeper. Mild 
mercurials are apparently preferred as remedies by Mr. Hill, and 
he observes that he agrees in every material respect with Dr. Gil- 
christ in his mode of cure. (Hill's cases in Surgery, to which is 
added an account of Sivvens. Edinburgh. 1772.) 

Dr. Adams, not being satisfied with the accounts that had been 
published, undertook a journey into Scotland, for the express pur- 
pose of viewing the disease. After examining several cases in their 
various stages, he arrives at the following conclusions which we 
give in his own words. " From all the above accounts, it is evident 
that sivvens is different from the venereal disease, though approach- 
ing nearer to it than any other morbid poison with which we are ac- 
quainted. The venereal gonorrhoea differs from the throat inflamed 
by sivvens, in the appearance of the discharge, and in the great dis- 
position sivvens shows to excite the effusion of coagulated lymph. 
The ulceration differs — the venereal being attended with callous edg- 
es and base, and sivvens consisting only of the clear phagedsenic ulcer, 
Secondary local symptoms differ—- the venereal retaining longer its 
copper appearance, and afterwards becoming more elevated, retain- 
ing more the colour of the skin, and the scab, when formed, being 
more scaly. In sivvens, the appearance is very early pustular, 
though I never could detect pus under the cuticle : I should there** 
fore, conceive the pus still less in quantity than in syphilis. It is 
probably thinner, that is, more truly lymphatic, as it hardens into 
an irregular dark brown crusty or stony scab. There is nearly the 
same difference between this and the venereal scab, as between the 
cow-pox and the small-pox scabs. Lastly, it is now universally ad- 
mitted, that sivvens never attacks the bones but by spreading from 
the soft parts, and that it yields earlier to mercury than syphilis. 1 ' 
An interesting case by Mr. Halliday, is given in which it appears 
that vaccination caused a suspension for six weeks, of this disease, 
■which for twelve months before, had kept possession of the skin 
and constitution. With respect to the tubercles from which the 
aame of Sivvens- is derived, Dr. Adams observes, that the practi- 
tioners with whom he conversed, agree with Dr. Gilchrist, is not 



geC VII. SCOTLAND AND CANADA. 277 

insisting on their appearance, as a mark of the disease. From the 
rapidity of the ulceration and the high inflammation in sivvens, itis 
evident, that it could not be generally propagated by the genitals, 
although the primary symptoms may, according to Dr. Adams, oc- 
cur in that situation. He observes, that if Cromwell's soldiers in- 
troduced the smoking of tobacco among the inhabitants of Scotland, 
the commonly received opinion concerning its origin may be rightly 
dated, even if the soldiers were free from the complaints, since a. 
custom prevails in several districts in Scotland, of a whole family 
using a single pipe. Dr. Adams concludes, by suggesting a prob- 
ability, that sivvens may be among the morbi in cole mentioned by 
Celsus, and cites from Astruc, the statements of various authors 
proving that similar complaints have been noticed previous to the 
introduction of Syphilis, among the Diseases of the genital organs, 
A similar opinion is entertained by Dr. M'Leod in the Dissertation 
referred to above. The following extract from Professor Frank's 
( a German Physician of eminence) Travels in France and England, 
as quoted in the Edinburgh Med. and Surg: Journal for July, 1807* 
is worthy of notice, particularly as the Author observed several ca- 
ses of Sibbens in the Hospital at Edinburgh. « In 1800, a disease 
appeared in Dalmatia, which had the characters of Syphilis, but 
was rather considered as a kind of Lepra, as it was communicated 
not only by sexual congress, but also by every kind of intimate con- 
nexion. Several thousand persons were already infected, when Dr„ 
Cambieri, District Physician at Fiume, pronounced the disease, 
which was called by the natives Scherlievo, a venereal affection, and 
the same uith the Sibbens of Scotland. His official communication 
on the subject, was transmitted by the court to my father, who per- 
fectly coincided with Dr. Cambieri in opinion. In consequence of 
which, the malady, when present, was not only treated with corro- 
sive sublimate, but also its farther propagation so completely check- 
ed, by the erection of hospitals, and the adoption of other regula- 
tions, that in the course of three years it was almost exterminated. 
On this occasion, Dr. Cambieri suggested the opinion that the 
Sibbens or Sherlievo is the original form of the venereal disease, as 
it first appeared in Europe. For it is well known, that it existed 
long before it was supposed that it communicated itself by sexual 
intercourse. Even the rapidity of its diffusion overall Europe, 
renders it probable that this was not the only way by which syphilis 
was then propagated." 

With respect to the complaint of a similar nature prevalent in 
Canada, according to Dr. Adams' examination, instead of the ac- 
count being written by a Dr. Bowman, and found among the papers 
of Governor Hamilton, as Dr. Swediaur states, itis more probable 
that the investigation was undertaken by a Mr. Beaumont a French 
Surgeon, who had been sent from Quebec by Governor Haldirnan-, 
to ascertain the nature of a disorder prevailing at the Bay of St. 
Paul, Canada. In one respect, according to the papers which Dr. 
Adams read, it agrees with sibbens, which is, that the contagion is 
of, en conveyed by smoking with the same pipe. We have been 
informed by Dr, JLe Barcn 5 Apothecary General to tbe Armv of 



278 OF LUES VENEREA IN Gl. IV. 

t*he U. S. that for the space of seven or eight years, during which 
he was stationed as Garrison Surgeon at Fort Mackina,he met with 
repeated instances of disease resembling Sibbens, among the Fur 
Traders and Natives. 

We add to this article, the following account of a disease resem- 
bling in some respects those which we have noticed, and particu- 
larly so in the mode of cure. It is extracted from the Edinburgh 
JMed : and Surg: Journal for Oct. 1809, and is entitled 

An Account of the Pseudo-Syfihilitic Cutaneous Disease, Radesyge, 

prevalent in some fiarts of Sweden and Norway. By Hugo H^ 

Boceer, M. D. Upsal. 

This distressing disease, known in Norway and among some Swe- 
dish practitioners by the Norwegian name Radcsyge, and in some 
parts of Sweden called Saltjluss, has not, till of late years, attract- 
ed particular notice, and is still most commonly confounded with 
the confirmed venereal hies, to which it, in many points, bears the 
strongest resemblance. Its being a degenerated form of the true 
syphilis, or a complication of that disease with scurvy, which has 
been suggested, has not been confirmed by any well-founded obser- 
vation ; and it is now, by all those who have made this matter a sub- 
ject of their investigation, thought to be a peculiar disease, per- 
fectly distinguished from both. The characteristic marks of this 
disease are, ill-conditioned sores, with excavated uneven bottoms 
and hard edges, arising either from reddish spots, or from copper- 
coloured tumours on various parts of the skin, without any previous 
venereal infection or primary symptom ; accompanied, during the 
progress, by swelling of the bones, sometimes by caries, and, un- 
less checked by proper remedies, ending with destruction of vari- 
ous parts, and total loss of health and life. 

Hardly any part exposed to the air has been found free from the 
disease. However, it seldom affects the face, the hands, and the 
private parts ; but most frequently the throat, inside of the mouth, 
upper and lower extremities, shoulders, neck, and trunk, and more 
particularly those places where a bone lies close to the skin. When 
it affects parts covered with a constantly moist skin, such as the fau = 
ces, it never begins with tumours, but with spots of a brighter co- 
lour ; whereas, on the skin of the exterior surface of the body, it 
either begins with spots or tumours, both of a darker appearance. 
Previously to the eruption, the diseased sometimes complain of ill- 
ness, general languor, pain in the limbs, exacerbated towards night,. 
&c; but frequently it comes on without any precursory symptom, 
and may, for some time, proceed under no alteration in the general 
state of health. 

The first symptoms often shew themselves in the throat, preced- 
ed by a sense of soreness, and a difficulty of swallowing. On ex- 
amining the parts, these will be found swelled, and a dark reddish 
colour spread somewhere over the surface, from the midst of which 
a whitish ulcer sooner or later breaks up, spreading somewhat in 
depth, and eroding the tonsils, uvula, or palate, with all the conse- 
quences of hoarsen cs-s of the voice, nasal pronunciation, kc. usual- 



Sec. VII. SCOTLAND AND CANADA. 279 

}y to be met with in syphilis. Not seldom, however, such inflamed 
spots disappear spontaneously, but are, in such case, always suc- 
ceeded by fresh symptoms of the disease on some other part of the 
body. Ulcers on the tongue, similar to those in the throat, are sel- 
dom met with except in children, where the infection has been con- 
veyed to them through the nipples of a diseased person, or some- 
times in elderly persons, where the tongue previously has been in- 
jured by a decayed tooth. In the inside of the cheeks, and on the 
lips, the first ulcer sometimes breaks up from a red spot, with an 
ash colour in the midst, but mostly in children, only previously to 
the next and usual symptom in them, an eruption round the anus. 
When the nose is attacked, the disease usually begins like a com- 
mon catarrh ; one of the nostrils becomes obstructed, and at length 
an ulcer penetrates the alae, communicating with the inner cavity 
of the nose, parts of which, in the course of time, sometimes will 
be corroded away. On the surface of the body the cubitus, olecra- 
non, and tibia are the parts mostly affected ; less frequently the 
thighs, humerus, shoulders, neck, and trunk ; and still more sel- 
dom the forehead, face, and hands. In all those places the ulcers 
may be preceded either by the above mentioned tumours,, or by 
small spots of a copper colour, somewhat similar to an herpetic 
eruption, dispersed here and there, and covered with scales, which 
at length run into each other to larger spots, and ulcerate. This is 
the most usual progress on the trunk. On the extremities, espe- 
cially where a bone is underneath the skin, tumours are the most 
prevalent. When any of these pans on the trunk or extremities 
are the first affected, the throat will remain unattacked, but not the 
contrary. If the parts round the anus are the seat of the eruption, 
this will take the form of small dark humecting excrescences, re- 
sembling warts, which at length ulcerate, but are not diffused to 
any extent. On the penis and scrotum ulcers sometimes, though 
seldom, occur ; they begin with tumours, but do not spread far, 
No instance, that I know of, has ever been found of the scalp being; 
attacked, or any part covered with hair, except the scrotum. 

Whatever may be the seat of these ulcers, varying in size from 
the smallest spot to that of a handVbreadth or more, they always 
are surrounded by a copper colour, considerably diffused ; they gen- 
erally have a round form, or somewhat approaching to that, and an 
appearance as if dug out of the substance ; they never suppurate, 
but discharge a thin, though seldom fetid, matter. Most frequent- 
ly they give no pain, except the larger ones ; but when they grow 
old, or occur in irritable constitutions, they are extremely painful, 
Tney often heal up spontaneously, but are soon followed by fresh 
ulcers in other parts. The marks which they leave behind upon 
the skin have a peculiar appearance, a shining white surface, with 
elevated strings running across ; an appearance which they never 
"will lose in any length of time. 

The tumours which this disease sometimes occasions in the bones, 
where these are covered only with skin (on the tibia, &c), are fre- 
quently without pain, and the skin above them unaltered, They 



280 OF LUES VENEREA IN Ch. 



IVr 



arc seldom followed by caries ; but, -when this happens, the ulcer 
never will heal till after an exfoliation of the injured bone. 

The disease often continues for a long while under appearance of 
health, and the general constitution scemsbut little impaired. Some 
irregularity, however, in the menstrual flux, sometimes occurs in 
consequence of the disease. But when it is suffered to proceed, 
and after its having affected the bones, it evidently will shew its in 
fluence upon the body by loss of strength, disturbed functions, and 
general emaciation. 

However difficult it often may be, from the mere appearance of 
the symptoms, to distinguish this disease from the confirmed lueS 
venerea, practitioners have thought themselves fully justified for 
appropriating to the radesyge a peculiar place among diseases, by 
the following diagnostic marks : That the radesyge never has been 
found to begin with primary symptoms, like the virulent gonorrhoea, 
a chancre, or bubo ; that it very seldom affects the parts of genera- 
tion, and not those places which are liable to the syphilitic infection 
(the glans and inside of the prepuce,) but the skin of the penis and 
scrotum ; that, to be effectual, the poison does not require to be 
brought into contact with such parts as are covered only with epi^ 
dermis, excoriated or wounded, but to any part almost of the whole 
body ; that being applied to a secreting membrane, it does not pro- 
duce an increased or contagious discharge, similar to that in a go- 
norrhoea, but an ulcer ; that it does not affect the parts so speedily 
as the venereal poison, but requires to be kept in contact with them 
a longer time ; that it does not, like the syphilis, attack parts cov- 
ered with hair; that the ulcers often heal spontaneously; that the 
spots on the skin in radesyge are larger, but less dispersed and of a 
deeper colour than those in syphilis ; that the tumors of the bones 
are of a less aggravating nature, frequently occasioning neither noc- 
turnal pain nor caries ; and, lastly, that the ulcers themselves, aris- 
ing sometimes to fungous excrescences, present some difference 
from the syphilitic, the matter adhering to the bottom not being so 
thick and yellow, but thin and white, and after its having been re- 
moved, the bottom shows itself not so red as in syphilitic ulcers, 
but with a deep purple colour ; nor are they, as these, offensive to 
the smell when kept clean, besides, that they spread less in the 
depth, and do not so easily affect the bones with caries. 

A contagious matter, brought into contact with the skin by various 
means, seems to be the only cause which gives rise to the disease. 
It appears to be of a less infectious nature than the syphilis, being 
almost solely confined to the lower order of people, who live close- 
ly together, but still leaving many unaffected during frequent inter- 
course with the diseased. Generally, however, it spreads among 
whole families. No kind of diet (fish-eating or such like) seems to 
have any material influence upon the origin of the disease, nor is it 
propagated by hereditary infection. Both sexes of every age are 
liable to it, but seemingly more females and children. 

The cure of the radesyge will sometimes prove very difficult 
when it has been of long standing; and in certain constitutions, or 
when complicated with other disorders^ especially with the syphilis^ 



Sec. VII. SCOTLAND AND CANADA. 281 

it will hardly yield to any treatment. In children the disease makes 
faster progress, but generally is much easier cured than in elderly 
persons. When the symptoms are confined to tumours, or to the 
before mentioned eruptions on the skin, the cure will be less diffi- 
cult than after the ulcers have broken up. These, as well as the 
former, are more tedious upon the lower than the upper extremi- 
ties, and on the extremities more than the trunk. The ulcers in the 
throat and upon the neck are the most easily removed. 

The only remedy hitherto found effectual against this disease is 
mercury. The symptoms will sometimes very easily yield to it, 
but as speedily return, and prove more difficult to cure the oftener 
mercury has been used. A variety of preparations have been used; 
and, among combinations, that of mercury with hemlock with suc- 
cess, where mercury alone had proved ineffectual. The prepara- 
tion mostly, and with success, used in that part of Sweden where 
the disease has occurred to my observation, has been the corrosive 
sublimate, in usual doses, assisted by some diaphoretic decoctions, 
by bathing, Sec. and occasionally by the internal use of the nitrous 
acid. The external treatment of the ulcers have seldom been of 
material consequence, and stimulating applications have often done 
harm. 

Whatever may be the preparation of mercury used in this dis- 
ease, it ought not to be introduced hastily into the system, or in 
large quantities, but the symptoms should be suffered to disappear 
slowly, and the remedy be continued for some weeks after. The 
combined use of mercury, internally and externally, vith success 
resorted to in syphilis, has proved improper in this disease. When 
too hastily removed, it will sooner or later return, becomes more 
difficult to cure, and at length mercury will have no effect whatever 
upon the disease. 

But even when much care has been taken of this circumstance, 
the diseased not seldom has a reiapse, and patients, apparently cur= 
ed, returning to the hospitals after months or years, give frequent 
and distressing proofs of the uncertainty of the cure. 

The foregoing account of the radesyge is chiefly founded upon 
observations made upon it, such as it has appeared in the north of 
Sweden, confirmed by what I have had an opportunity of seeing 
myself in Norway when travelling there, Whether any thing else, 
or materiahy different, has been remarked there, or on the west 
coast of Sweden, where the disease is perhaps more prevalent, my 
knowledge at present does not enable me to decide, nothing but 
some few observations from Denmark having been published upon 
the subject. 

Edinburgh, 3d August, 1809^ 

Ed 



VOL. If-. 



282 OF PROPHYLACTICS Cll. TV. 

SECT. VIII. 

Of Prophylactics in Lues Venerea. 

TO prevent infection is an object of the first im- 
portance in all diseases, but there is none in which our 
endeavours have proved less successful than in this. 
As the pleasures and safety of mankind are both inter- 
ested, Prophylactics in Lues Venerea have long been 
an object of attention ; but hitherto, notwithstanding 
all the boasted specifics with which every kingdom of 
Europe abounds, nothing has been discovered upon 
which any dependence can be placed. 

At first view one would not doubt of ablution alone 
proving sufficient for preventing infection. As the parts 
to which the matter of infection is applied are alto- 
gether external, and as a considerable length ot time 
commonly elapses before any effects are produced by 
it, we might with confidence expect that bathing the 
parts in warm water, or any other liquid, could scarce- 
ly fail of removing the contagious matter. This, how- 
ever, is not the case ; for although some advantage 
may occasionally be derived from careful ablution we 
have daily proofs of ils failure, even when practised 
with all manner of attention. 

This must probably arise from the virus being ei- 
ther exceedingly subtile, or so very adhesive that it 
cannot be sepaiated from parts to which it has found 
access by any means that have as yet been employed. 
In this view, therefore, two objects present themselves. 
Any application to be made use of should not only be 
of a very penetrating nature, but capable of destroy 
ing that connection by which the virus is thus made to 
adhere to the parts to which it is applied. I also think 
it probable that some advantage may be derived from 
combining mercury with whatever is best adapted to 
these purposes. By acting as an antidote it may serve 
to destroy such parts of the venereal poison as the oth- 
ers have not been able to remove. 

Crude mercury, triturated with honey and with tur- 



Sec. VIII. IN LUES VENEREA. 283 

pentine, and mixed with a sufficient quantify of water, 
has been used as a wash for this purpose ; but the in >st 
convenient way of employing mercury here is in the 
form of a w r atery solution of corrosive sublimate. It 
may be used of various degrees of strength, from the 
quantity of one grain to three grains of mercury in the 
ounce of water. More than this proves irritating and 
corrosive. 

As it is probable that the virus proves more adhesive 
than it otherwise would be by combining with the mu- 
cus of the parts to which it is applied, all such articles 
as prove solvents of mucus, or that in a more particu- 
lar manner destroy its tenacity, may with propriety be 
employed in the composition of an antisyphilitic wish. 
Upon this principle lime water may be used with ad- 
vantage ; also the caustic fixed alkali, and even the 
caustic volatile alkali so diluted with water as to ad- 
mit of their being applied with safety. 

No harm can ensue from the external use of any of 
these articles in the form of a wash, and more advan- 
tage, I have reason to think, may be derived fromttn-rn 
than is commonly obtained From the use of those secret 
specifics which the interest of individuals and credulity 
of our young people have occasionally brought into no- 
tice. I think it right, however, again to remark, that 
none of them'can with certainty be relied upon, and 
that in no instance ought any of them to be injected 
into the urethra, as preventives of Gonorrhoea. VYhen 
the disease has actually taken place, they may, when 
much diluted be used with freedom ; but they cannot 
be employed but with much risk of inducing inflam- 
mation when of such a strength as can have any influ- 
ence in dislodging the virus, by dissolving or destroy- 
ing the mucus with which it is combined. Whether 
these specifics to which I allude have any of the arti- 
cles which I have mentioned for their basis or not I 
cannot determine, but when used as injections they of- 
ten do much harm by exciting pain, and such a con- 
stant inclination to pass urine as proves exceedingly 
distressful. 



234 OF LUES VENEREA Ch. IV, 



The best Prophylactic in Lues Venerea, is circumcision. " Jews 
and Mahometans/' observes Mr. Howard, " from the constant ex- 
posure of the glans and loss of the prepuce, have the cuticle of the 
balanus (glans penis') of much firmer texture than those who have 
not been circumcised, and they are from this circumstance, much 
less subject to gonorrhoea and chancre, than the rest of mankind." 
In proof of this, he quotes Fallopius, who states that even in his 
day, scarcely two out of a thousand persons were infected, whose 
prrputia were short and whose balanci were kept constantly uncov- 
ered. Patio est quoniam detects glandis durius corium redditur 
atCjiw. callodus. Persons who have short preputia and hence liable 
to abrasion in coitu, are very subject to be infected. 

Ep, 



SECT. IX. 

Of Lues Venerea as inducing other Diseases. 

AS the virus of syphilis is often difficult to eradi- 
cate, and the disease being frequently known to break 
out again long after a cure has been supposed to have 
been accomplished, the fears of patients have induced 
them to suspect that it cannot with any certainty be 
removed after having appeared as a general disease of 
the system, and even to consider it as the cause of ma- 
ny other diseases. 

Even practitioners have been divided in their opin- 
ions upon this. The result of my observation has al- 
ready t-een given on the power of mercury in curing 
the disease. In section fourth of this chapter I have 
endeavoured to show that where failures have happen- 
ed they must in a great measure have arisen either from 
the misconduct of patients when under mercury or 
from too small a quantity of the remedy being given* 
But while I am clearly of this opinion I at the same 
time think that Lues Venerea is often the cause of 
other diseases, which frequently prove fata) from want 
of a proper application of mercury, by which a cure 
of ail of them might be easily obtained. 



geC. IX. AS INDUCING OTHER DISEASES. 285 

In the preceding parts of this work a description is 
given of all the ordinary symptoms of Lues Venerea, 
and of the method of treatment appropriated to each; 
but if the opinion which I am now endeavouring to 
support is well founded, this disease, it is evident, 
must occasionally appear under other forms. 

We have already had occasion to observe that Lues 
Venerea, when not interrupted in its course by the use 
of mercury, usually makes a certain progress, and that 
the symptoms make their appearance with some regu- 
larity : But when mercury is employed, and not given 
in quantities sufficient for eradicating the virus, al- 
though all the symptoms may thereby be suspended, 
the disease will certainly appear either in the same or 
some other form at some future period. In this case 
the disease generally shows itself by one or other of 
the symptoms that have been described, but occasion- 
ally we meet with it under a variety of other appear- 
ances; the virus, instead of producing the ordinary 
symptoms of Lues Venerea, tending rather to induce 
other diseases. 

This I know is denied by many, who alledge that 
syphilis is never productive of other diseases; but I 
have met with it in such a number of instances, and 
these so evidently marked, that I consider the fact as 
certain. The virus of syphilis will not produce any' 
disease that depends upon a specific contagion, such as 
small-pox, measles, itch, and some others, but I have 
much reason to think that a great variety of other dis- 
eases are induced by it. It may be asked in what 
manner can syphilis act in producing other diseases, 
and what evidence can be given of its ever having 
done so ?' In answer to this I may observe, that it is 
often difficult, and sometimes impossible, to explain 
the action of causes in producing diseases. We may 
easily, however, suppose, where the virus of syphilis 
exists in the system, but not in sufficient force to show 
itself by the usual and more obvious symptoms of the 
disease, that it may, however, in various instances be 
capable of exciting a great deal of derangement, and 
even many diseases which otherwise might not take 



286 OF LUES VENEREA CI). IV* 

place, and that it will more especially be apt to pro- 
duce those diseases to which the constitution is predis- 
posed, or those to which the patient is rendered liable 
by exposure to particular occasional causes. If the 
virus can exist in the system for a considerable length 
of time without shewing any external mark of disease, 
and of this few I believe will doubt, it is difficult to 
conceive that it should not produce both general de- 
rangement and particular organic affections; and ac- 
cordingly I believe that it more frequently does so 
than we are usually led to imagine. The evidence 
which I could give of this would be exceedingly am- 
ple, as I could relate a very extensive collection of 
cases in a great variety of diseases in which it actually 
happened; but the extent of this publication renders 
it necessary to confine the proofs of it within narrow- 
er limits. The diseases induced by the venereal virus, 
of which I shall give instances, are phthisis, asthma, 
rheumatism, dropsy, head-ach, epilepsy, and mania. 

In the month of October 1783 I was desired to visit 
a gentleman at some distance from town, with an ex- 
tensive foul ulcer upon his left shoulder. This was 
mentioned as the most material part of his distress; 
but I also found that he had for several months labour- 
ed under all the most alarming symptoms of phthisis, 
such as severe cough, spitting of purulent matter, 
pains in the breast and sides, night sweats, quick pulse, 
and an emaciated state of the body. These symptoms, 
however, did not excite the attention of the patient 
iioj of his friends so much as the ulcer upon his shoul- 
der, which, from the great quantity of matter which it 
discharged, and the great length of time which it had en- 
dured, was considered as the cause of his weakness as 
well as of all the other symptoms. 

The appearance of the sore giving cause to think 
that it might be venereal, I mentioned this to the sur- 
geon in attendance, as well as to my patient, with a view 
to discover whether from the history of the case, and 
from his previous course of life there was any ground 
for suspicion. Tie answer which I received to this 
inquiry was. that soon after the Hist appearance of this 



SeC. IX. AS INDUCING OTHER DISEASES. 287 

ulcer, about three years before the time of my being 
consulted, an ulcer had appeared in his throat, accom- 
panied with some other symptoms of syphilis. For 
the removal of these he had been put under a long 
course of mercury, which had proved successful ; and 
as he had not since that period run any risk of being 
infected he did not suppose it possible that the ulcer 
upon his shoulder, or any of his other symptoms could 
be venereal. Having found, however, that the mercu- 
ry, although long continued, had never been given in 
greater quantities than to render the mouth moderately 
sore, and that for a considerable time an eruption re- 
sembling venereal blotches had prevailed over his breast 
and arms, I did not hesitate to sav that the infection 
had not been eradicated, and that he ou^ht immedi- 
ately to enter upon a full course of mercury. 

The chief objection to this was the debilitated state 
of our patient, and the quickness of pulse, with other 
symptoms of fever, which prevailed in a very conside- 
rable degree, the pulse at this time beating upwards of 
130 in a minute. Even these considerations, however, 
did not deter me from advising the use of mercury 5 
having even at that time seen more than one case of a 
similar nature, where the lungs were evidently affected? 
and in which a cure was obtained by mercury; and 
judging from the whole history of the case that the 
phthisical symptoms might be kept up by the syphilitic 
virus, I observed to my patient, that if my conjecture 
was well founded, these symptoms, as well as the oth- 
ers, would gradually abate on the mercury taking ef- 
fect. I also said to his friends, that in such circum- 
stances the mercury could not add much to his hazard, 
however severely it might operate ; the nature and se- 
verity of his symptoms being such as gave no cause to 
imagine that he could live above a few weeks if some, 
unexpected alteration did not take place. 

The patient himself having readily acquiesced a 
course of mercury was immediately prescribed. At 
first he rubbed in a drachm of strong mercurial oint- 
ment every evening. This came to be repeated morn- 
ing and evening ; and as his cough and fever were not 



28# OF LUES VENEREA Ch. tti 

increased by it, and the stale of his mouth enabling bim 
to bear it, the quantity at each application was increas- 
ed at the end of eight days to a drachm and a half. 
The ulcer was dressed with common wax ointment. 
About the end of a fortnight it became clean, which it 
had never before been, and any uneasiness with which 
if had previously been accompanied was now removed. 
The blotches upon his skin had begun to yield, and 
even the febrile symptoms, instead of being increased 
by the mercury, were somewhat abated. His mouth 
became exceedingly sore ; but although a- good deal 
of salivation was excited the same quantity of mercury 
was continued. This I was induced to insist upon 
from our having now very satisfactory evidence of alt 
bis symptoms being venereal, for even the cough and 
purulent expectoration became moderate in proportion 
to the quantity of mercury that was exhibited. By 
the end of the sixth week the cough was nearly gone ; 
the blotches were almost entirely removed ; the ulcer 
continued perfectly clean and much contracted, and 
bis pulse did not now beat above ninety strokes in a 
minute. 

In the course of a fortnight from this time, that is, 
after he had taken mercury for the space of eight 
weeks, scarcely any remains of the blotches could be 
perceived : The sore was reduced to the fourth part of 
its original extent ; but about this period it became 
nearly stationary, for which it was touched every se- 
cond or third day with lunar caustic. At the end of 
another fortnight it was completely cicatrised ; but the 
infection having been of long duration, I judged it 
proper to continue the mercury three, weeks longer, 
being thirteen v*eeks in all. He had now been many 
weeks entirely free of cough. His pulse was about 
its natural standard ; and as he had been allowed nour- 
ishing diet during the whole course, he was even con- 
siderably improved in appearance and strength. By 
the beginning of the ensuing summer he was equally 
strong as he had ever been at any period, and when I 
last saw him, about three years ago, he had continued 
entirely free both of Lues Venerea and phthisis, 



Sec. IX, AS INDUCING OTHER DISEASES. 28S 

In the beginning of January 1784 I was desired to 
visit a patient newly come to town, with sores on dif- 
ferent parts of his body and limbs, and he had also for 
a considerable time been distressed with asthma. It 
was chiefly however for the sores that he applied for 
advice, as he had been led to consider asthma as a dis- 
ease for which there was no remedy. There was one 
large ulcer immediately above the great trochanter of 
the right thigh ; one upon the middle and most promi- 
nent part of each leg, both of which penetrated to the 
tibia; one upon the breast, where the sternum appear- 
ed to be thickened, although not carious; one upon 
the right side, upon the seventh and eighth ribs ; and 
a small sinous ulcer upon the middle and outside of the 
right arm, which, upon probing, was found to run to 
the surface of the ulna, which was rough for the space 
of an inch. Besides these there were several small 
ulcers upon the toes of both feet. These, as well as 
the others, were all foul, and discharged a thin, foetid 
matter; and being accompanied with that erysipelatous 
kind of redness which frequently surrounds the mar- 
gins of venereal ulcers, I was thereby led to suspect 
them to be of a venereal nature. The patient men- 
tioned, as reasons for thinking that I wa3 mistaken, 
that these ulcers were now of seven years continuance, 
and on the suspicion of their being venereal that he had 
taken mercury to a considerable extent at three differ- 
ent times, each course having been continued for nine 
or ten weeks; and although he had from all the three 
derived benefit, that none of the sores had healed by 
the effects of any of them, and that some of them had 
even become worse soon after the last course of mer- 
cury was left off. The asthmatic symptoms were now 
of five years duration. They began without any ob- 
vious cause, and had gradually become more violent.* 
nor had any remedy that had been employed for them 
given him relief, excepting opium, and even this was* 
merely temporary. Besides a constant difficult breath- 
ing, he was liable to periodical attacks of a more se- 
vere nature, which occasionally came to such a height 
as to endanger suffocation. These occurred most fre- 

YOJL. II. 33 



290 OF W7ES VERE1 E I CI). 

quently during sleep, and, for the most part, with 
much regularity, about three o'clock in the morning. 

The patient, who was now about forty-fife years of 
age, acknowledged that in hi? earlier years he had suf- 
fered much from Lues Venerea, but having been led 
to suppose that he tiad already taken more mercury 
than was necessary, it was with difficulty thai I per- 
suaded him to enter upon a farther course of it. The 
mure, however, that I beard of the rise and progress 
of his complaints the more I was convinced of their 
being venereal; for besides, the appearances of t tic 
sores which I have mentioned, 1 found upon enquiry 
that he tiad never taken a full course of mercury, for 
although it had always rendered his gums sore, he had 
never used it in such quantifies as to require confine- 
ment. Neither had any of the attempts which had 
been made- to cure the sores by external applications 
proved successful. A great variety had been employ- 
ed, but although some of these had rendered thera 
more clean than they tiad been before, and procured 
a discharge of better matter, no permanent advani 
had been derived from any of them. 

These considerations determined me to give a deci- 
sive opinion on the propriety of his taking mercury in 
larger quantities than lie had ever as yet done. This 
induced him to agree to it, and he entered upon the 
course on the 14th of January. At first he nibbed in 
a drachm of mercurial ointment every night, and took 
one of the blue piils evening and morning. In the 
course of eighl days he used two drachms of the oint- 
ment dally, and the same number of pills were con- 
tinued till his mouth became exceedingly sore, and a 
good deal of salivation induced which happened at the 
end of a fortnight. At this period the pills were left 
off, and only a drachm of the ointment employed dai- 
ly. The common wax ointment was applied to the 
sores and renewed morning and evening. 

Till he entered upon this course the sores had at all 
times given him much uneasiness. They had never 
produced acute pain, but they were accompanied with 
an uneasy, itchy sensation, which frequent!} deprived 



Sec. IX. AS INDUCING OTHER DISEASES. 291 

him entirely of rest. Before the end of the third week 
this was completely removed ; the sores were become 
clean, and the discharge of a better consistence; at the 
same time that his asthmatic symptoms were by no 
means so severe. As by this he was convinced of the 
propriety of the course of mercury, he readily submit- 
ted to the distrcssand inconveniency which it produced, 
and kept his mouth fully affected during the whole time 
of it. By "the beginning of March, that is, after having 
taken mercury for nearly seven weeks, all the sores 
were entirely healed excepting that upon the outside 
of the thigh and those upon the legs. Even these 
were much diminished, and the cure in all the three 
seemed to be retarded only by the state of the bones 
beneath, which were found to be denuded of the peri- 
osteum, and even in some parts rough. These, as well 
as the others, had been dressed with mild wax ointment 
from the first, and excepting the laying open the sinus 
upon the fore arm, no farther attention had been given 
to any of them. Fie now breathed easily and had not 
experienced any severe fit of asthma from the time that 
his mouth became first fully affected with the mercury. 
The course was carried on in the same degree to the 
end of the thirteenth week, when judging from the 
quantity of mercury employed, and the regular man- 
ner in which it had been taken, that the virus by which 
his disease seemed to have been produced must be 
eradicated, 1 caused him to leave it off. The asthma 
was entirely gone, and ail the sores continued firm and 
well, excepting the three 1 have mentioned. I now 
supposed, however, that these were kept up entirely 
by the carious bones on which they were seated ; and 
as a cure could not be looked for till the diseased parts 
exfoliated, and as this might probably be tedious, I 
advised him, as soon as he could with safety venture 
upon a journey, to go home, and to do nothing with a 
view to the sores but dressing regularly with red pre- 
cipitate ointment in order to prevent the growth of a 
fungus, with which all the three were covered. This, 
with the occasional use of calcined alum, prevented 
the fungus from being considerable ; but it was not till 



292 OF LUES VENEREA Cll. IV, 

a year bad elapsed that any of the sores healed. About 
this period an extensive exfoliation appeared to be 
coming away from the tibia of the right leg. He now 
came to town, and by cutting into it I got it easily out, 
and the sore healed in a fortnight. The sore on the 
other leg healed in a similar manner at the end of three 
or four months after a small spiculated portion of the 
tibia had come away, but the ulcer upon the trochanter 
has not healed. Several small pieces of bone have from 
time to time come away, but I conclude that more 
must be thrown out before a firm cicatrix will form ; 
for although now reduced to the appearance of a nar- 
row sinus, which frequently heals, it always bursts out 
again. It is not, however, productive of much incon- 
venience ; and on account of the situation of the bone, 
I think it better to trust to time alone than by means 
of any operation to attempt to promote the exfoliation 
of the diseased parts. No return of asthma has taken 
place, and he is now in good health. 

In the month of May 1789 I was desired to visit a pa- 
tient, by trade a brewer, aged forty, and very corpu- 
lent. For several years he has been liable to periodi- 
cal returns of asthma, and during all that period his 
"breathing had been difficult, insomuch that he had for 
the most part been obliged to sleep nearly in an erect 
posture. He had been liable to frequent and very dis- 
tressful palpitation of the heart, and his pulse was at 
all times frequent and irregular. Other practitioners 
had previously been called, and, as is usual in such 
cases, different opinions were formed of the cause of 
the disease. By some it was considered as gout ; others 
judged it to proceed from hydrops pectoris, while by 
some it was supposed to constitute what of late has 
been termed angina pectoris. The patient himself, 
however, was of opinion, that all his symptoms ori- 
ginated from what he termed an ill-cured pox. He 
informed me that in his earlier years he had suffered 
much from frequent attacks of syphilis, and not hav- 
ing taken mercury in a regular manner ; particularly 
from the last attack, and to which this affection of his 



SeC. IX. AS INDUCING OTHER DISEASES. 293 

breathing had succeeded : From this he was convinced 
that the virus had not been eradicated. 

No evident symptoms of Lues Venerea, however, 
could be discovered; so that I could not venture to 
advise a course of mercury as my patient wished me 
to do. Purgatives, diuretics, and blisters, were re- 
peatedly employed, but with no advantage; and some 
relief being derived from opiates, he was at last induc- 
ed to trust entirely to a large dose of laudanum taken 
at bed-time, and a lesser dose in the morning. In this 
situation I left him in the month of September, nor 
had I again occasion to see him till the month of April 
1790, when I was called on consultation with the sur- 
geon of the family for an ulcer which two months be- 
fore had appeared upon the right side of the nose. 
At first this ulceration was so inconsiderable as scarce- 
ly to excite his attention ; but, as it soon began to 
spread, various applications were employed, from the 
mildest to the strongest escharotics; but although 
these, with the occasional use of lunar caustic, had 
proved useful, by preventing the growth of fungus 
which had previously prevailed, still the sore continu- 
ed to extend, and at this time had spread to the oppo- 
site side of the nose. Upon inquiry I found that in 
the month of November, some days after exposure to 
infection, a chancre had appeared upon the glans pe- 
nis; but as it healed by being twice touched with 
caustic, and which he had done without the know 
ledge of his surgeon, he had not thought it necessary 
to enter upon the use of mercury. 

At this time the difficulty of breathing and distress- 
ful palpitation of the heart were more severe than ihey 
had ever been at any period ; but the account which I 
had received of this recent infection, the progress 
which the ulcer was daily making, and the inefficacy 
which had already been experienced of local applica- 
tions, determined me to advise an immediate and full 
course of mercury. Being informed that mercury did 
not readily affect him, both the internal and external 
use of it was advised ; so that in the course of ten da vs 
(his mouth was rendered as sore as he could possibly 



294 OF LUES VENEREA Ch. IV. 

bear it, and he salivated to the quantity of between 
two and three English pints a day. The sore was 
dressed with common wax ointment. 

In the course of three weeks from his entering upon 
the use of mercury the sore was considerably dimin- 
ished, and at the end of six weeks it was entirely heal- 
ed; but to the surprise and satisfaction of all concern- 
ed all his other symptoms became better on the mer- 
cury taking effect. The difficulty of breathing was 
soon much relieved, the palpitation vanished entirely, 
and the pulse fell to its natural standard. It was seve- 
ral weeks before the asthmatic affection left him entire- 
ly, but this happened before the end of the course, 
which was continued to the end of the third month ; 
and he has not since that period experienced any re- 
turn of his disorder. 

In this last case it may be a question whether the 
patient laboured und^r syphilis at the time when I 
first saw him or not : He himself imagined that he did ; 
and on finding afterwards that the disease in his breast 
was completely removed by mercury, when rendered 
necessary by the presence of a more obvious symptom 
of the disease, I came also to be of the same opinion, 
and this induced me to give the mercury in large quan- 
tity, and to continue it longer than would have been 
necessary for the cure of a more recent infection. 

In March 1787 I was consulted by a gentleman of 
fortune in the south of England. His case was de- 
scribed to be a severe rheumatic affection, with which 
he had been afflicted for the space of eighteen months. 
After much exposure to cold and wet weather in the 
course of hunting, he was attacked with severe pains 
in all his joints, particularly in the shoulders, wrists, 
knees, and ancles. These continued in some degree 
from the first approach of the disease, but he had oc- 
casionally been distressed with severe pains in his 
back, loins, and hip-joints, to such a degree as not to 
be able to move for two or three weeks together but 
with an unsupportable increase of pain. His fingers 
and toes also became swelled and painful; and as the 
balls of the great toes had been particularly affected 



Sec. IX. AS INDUCING OTHER DISEASES. 295 

his disorder by some had been considered as gout. At 
the time of my being consulted the joints of his fin- 
gers were so much swelled that he could not even sign 
his name, but the chief cause of his distress at that 
time was a swelling of his right knee. The swelling 
and pain in his other joints had at different periods pre- 
vailed in various degrees; they even at times left him 
entirely ; but the right knee had continued swelled and 
painful from the first, and at this period it was repre- 
sented as being nearly double the size of the other. 
There was accordingly much tension, and a very ex- 
tensive fluctuation had for seven or eight weeks been 
discovered in the superior part of the tumour. The 
skin, however, was no where discoloured. He was at 
this time thirty-two years of age. When first attacked 
with the disorder he was full and vigorous, but now 
much emaciated. His pulse, however, was good, for 
although for a considerable time a good deal of fever 
prevailed, it had now left him entirely, his skin was 
cool, and his pulse between seventy and eighty in a 
minute. 

The remedies he had employed were these : At first 
he was repeatedly blooded ; the pained parts had been 
rubbed with a variety of stimulating applications, such 
as volatile liniment and tincture of cantharides, and 
blisters had been frequently applied. He had taken 
James's powders, camphors, and opium ; but the lat- 
ter being the only remedy from which he derived re- 
lief, the others had long been disused. Sixty drops of 
laudanum taken at bed-time, and twenty-five in the 
morning kept him for the most part tolerably easy, but 
he experienced much distress whenever these were 
omitted. The following is the advice which I propos- 
ed to him : 

1. That two drachms of a weak mercurial ointment 
containing only a fifth part of mercury, should be rub- 
bed upon the swelling of his knee evening and morn- 
ing for the space of twenty minutes each time, and 
continued five or six weeks if it did not excite saliva- 
tion, 



2=96 OF LUES VENEREA Cll. IT. 

2. That he should use a warm bath of sea-water ev- 
ery second night: The whole body to remain immers- 
ed for the space of twenty-five minutes, or half an 
hour, and a quantity of the warm water to be poured 
from the height of three or four feet upon the swelled 
knee at each time of using the bath. 

3. Instead of laudanum at bed-time, that he should 
take fifteen or twenty grains of Dover's powder. 

4. That he should wear flannel next his skin, not 
only upon the diseased knee, but over his whole body. 

5. If by these means the swelling did not abate in 
the course of four or five weeks, that blisters should 
be applied to it ; the first to be applied upon that part 
of it in which the fluctuation was discovered, and the 
others alternately on each side of the joint. 

I heard again from him in the month of June, when 
he informed me that he had been prevented from 
using the mercury by a physician who had been con- 
suited on the receipt of my opinion. Being afraid 
that his debility might be increased by the mercury, 
be had desired that it might not be used, but all the 
other parts of the course which I had pointed out had 
been complied with. His general state of health was 
better, and by the use of the warm bath and Dover's 
powder his pains had been much relieved, but they 
always recurred on these remedies being laid aside 5 
and the swelling of the knee was nearly in the same 
state as when he first applied to me. Besides this, he 
had been attacked with a painful swelling on the up- 
per part of his right shoulder, which, after becoming 
red and tender, had ended in an extensive foul ulcer 
This giving rise to much anxiety, for the sore was dai- 
ly becoming deeper, he was particularly anxious to 
have some remedy pointed out for it. 

In return to this, I desired that the mercury might 
still be employed with a view to remove or lessen the 
swelling of the knee, and I gave him formulae of dif- 
ferent ointments as dressings for the sore on the shoul- 
der. I said, however, that he must depend chiefly on 
the surgeon in attendance for the treatment of this 
-ore ; hut being within forty or fiftv miles of London, 



See. IX. AS INDUCING OTHER DISEASES'. 29? 

I advised him, if he did not soon get better, to go there 
for the advantage of a consultation. 

I did not hear of him again till the month of Sep- 
tember, when he arrived in Edinburgh. He now in- 
formed me that he had gone to London on the receipt 
of my second letter, and that he had been advised to 
the use of guiacum ; a deep-seated pea issue had been 
inserted on the inside of the swelled knee ; and differ- 
ent ointments had been given him to apply in succession 
to the sore on the shoulder. Having continued, how- 
ever, under the regular application of these for up- 
wards of two months, and no advantage accruing from 
them, he determined at last on coming here. The 
pains over his joints were still very universal, almost 
every joint being more or less swelled, but they were 
not any where so severe as they had at first been. The 
swelling on the knee was very considerable, and a fluc- 
tuation was perceived, reaching from the patella, be- 
neath the rectus muscle, nearly to the middle of the 
thigh. The skin, however, was not discoloured, and 
the joint was still in some degree capable both of 
flexion and extension. But the symptom which gave 
him most uneasiness was the ulcer upon his shoulder, 
which had now extended from the top of the shoulder 
over the clavicle, and down to the middle of the hu- 
merus. It had already destroyed some part of the del- 
toid muscle, by which the motion of the arm was 
much impeded, and a considerable portion of the cla- 
vicle was become carious. 

This ulcer he had lately been informed was of a 
scrophulous nature, but as to me it had many of the 
appearances of a venereal sore, I decidedly said so, and 
on inquiry I found that there was still farther cause 
of suspicion. About three months before he was first 
attacked with rheumatism two small chancres appear- 
ed upon the penis, which were removed in the course 
of eight or ten days by the application of caustic, and 
the use of a very small quantity of mercury. The 
quantity he could not exactly ascertain, but. he knew 
that he had not taken it for a week, and that his mouth 
had never been sore with it, I also fonnd, that nearly 

vol. i r* 38 



298 OF LUES VENEREA Ch. IV. 

about the time at which his shoulder became sore an 
eruption had appeared upon different parts of his 
body, particularly among his hair and on his breast, 
but which till now he had not mentioned, as he had 
not supposed it to be of any importance. This, how 
ever, along with the other circumstances of his situa- 
tion, determined me to advise a full course of mercu- 
ry, and which he the more readily agreed to from eve* 
ry other remedy which had hitherto been tried having 
proved ineffectual. 

He entered upon this course on the sixth of Octo- 
ber. At first half a drachm of the blue ointment was 
rubbed in evening and morning, and one of the blue 
pills, with two grains of opium were given at bed- 
time. The opium was necessary not only for pre- 
venting purging, but from the patient having been in 
the habit of taking it. At the end of ten days, as the 
mouth was not affected, nor any other symptom pro- 
duced by the mercury, the quantity both of pills and 
ointment was doubled. This, in the course of a fort- 
night rendered the mouth exceedingly sore, and pro- 
duced some salivation ; but the uneasiness excited by 
this was amply compensated by the relief which he 
had obtained. Although the pains in his joints had 
abated they had still given him much distress. This 
was almost entirely removed in the course of a day or 
two after his mouth became evidently affected, and 
being anxious to avoid the habit of taking opium. I 
found at the end of another week that he had left it 
off, and that he slept better without it than he had 
done for two years before. Still the knee continued 
nearly of the same size, but the sore on the shoulder 
was much better. Under the same dressings which he 
had for some time been using the surface of the sore 
soon became clean, the discharge was of a better con 
sistence, and much less offensive, and in some parts new 
granulations had begun to appear. 

The mercury was continued in such quantities to 
the end of the third month as was necessary to keep 
the mouth completely sore during the whole period, 
and during the course of the last of these months he 



Sec. IX. AS INDUCING OTHER DISEASES. 299 

drank daily an English quart of a strong decoction of 
sarsaparilia, guiacum, and mezereon.* At the end of 
six weeks all the swellings of the smaller joints, parti- 
cularly those of the fingers, were entirely removed, 
and even the fulness of the knee was considerably re- 
duced. The sore on the shoulder was already con- 
tracted to one half of its former size, and at the end 
of another fortnight the whole of it was cicatrised ex- 
cepting those parts seated upon the carious part of the 
clavicle. At this time too the knee had assumed a 
very different appearance. It was not only much 
lessened but the fluctuation above the patella was en- 
tirely gone. No application had been made to it but 
a portion of the mercurial ointment, wnich, morning 
and evening, was rubbed upon it. In the course of 
the tenth week a thin, long exfoliation took place 
from the clavicle, and the small sore which remained 
healed in a few days thereafter. He continued here 
for several weeks after the course was over, and on 
going away, although the knee was about an inch in 
circumference larger than the other, it gave him no 
uneasiness, not even in walking; but a very consider- 
able degree of stiffness remained in the joint of the 
right shoulder, and which I informed him might pro- 
bably continue for a great length of time, perhaps even 
for life, owing to a considerable portion of the deltoid 
muscle having been destroyed by the ulcer* In order 
to lessen this stiffness as much as possible, I desired, as 
soon as the skin was sufficiently firm to admit of it, 
that the whole shoulder and arm should be rubbed 
evening and morning with some emollient oil, and if 
no relief was obtained from this, that he should go to 
Bath, and have the warm waters of that place pump- 
ed upon it. I found, however, after two years had 
elapsed, although in every other respect he continued 
well, that his shoulder remained in nearly the same 
state. 

Many cases have fallen under my care of venereal 
pains which resembled rheumatism =o much that it w?. c 

Vide kppen&i:& Vol I "N'n. 46 



300 OF LUES VENEREA Ch. IV. 

difficult to distinguish of what nature they were ; but 
in a great proportion of these, circumstances were dis- 
covered upon enquiry, by which the distinction was 
sufficiently well marked. In this, however, as well as 
in some others which I have met with, the symptoms 
were for a long while so evidently rheumatic that there 
was not the least cause to suspect them to be venereal. 
Venereal pains almost universally fix upon the middle 
parts of limbs ; very rarely upon the joints only. Now 
in this case the joints only were affected, as very com- 
monly happens in rheumatism, and the palient having 
been much exposed to the most frequent cause of that 
disease, while no symptom occurred that had any ap- 
pearance of being venereal till these pains had contin- 
ued upwards of twenty months. The ulcer on the 
shoulder was the first symptom that created suspicion ; 
for when I prescribed the mercurial ointment, it was not, 
I must acknowledge, from thinking that the patient was 
infected with Lues Venerea, but from experience of 
its utility in similar affections of the joints proceeding 
from other causes. 

An officer of the navy, who had been exposed to 
hard service both in the East and West Indies was 
seized with severe rheumatic pains in spring 1782. At 
first they were confined to the large joints, but after- 
wards a soreness prevailed over his whole body. He 
was about forty years of age, and till this time he had 
been strong and healthy. 

All the remedies usually employed in rheumatism 
were advised. Flannel was applied, and the pained 
parts were rubbed with a variety of stimulating appli- 
cations ; blisters were applied to the parts that were 
most painful ; sudorifies were used in various forms ; 
and in the course of the first three years he had used a 
great variety of baths. He bathed at first in warm salt- 
water, and afterwards went both to Buxton and Bath ; 
and he had last of all used the cold bath. JNo advan- 
tage, however, was obtained from any of these ; and at 
last the only remedy which he employed was a large 
ilose of laudanum at bed-time. 

He had frequently been liable to pain and some de- 



Sec. IX. AS INDUCING OTHER DISEASES. 301 

gree of fulness in the region of the liver, which he at- 
tributed to his residence in India. This, however, 
never gave him much uneasiness, till the winter of 1785, 
when a soft diffused swelling, larger than it had ever 
been, and accompanied with some pain, was perceived 
exactly on the site of the liver. The tumour became 
larger, and at last a fluctuation of matter was perceived 
in it. In this situation I first saw him in the month of 
April ; and the chief reason of my being called was to 
judge of the propriety of discharging the matter by an 
operation. This, however, I found to be inadmissible. 
The matter lay so deep that it did not point any where, 
and the fluctuation was very obscurely felt. I there- 
fore in the mean time advised, that mercury, which he 
was then taking, should be given in greater quantities, 
so as to render his mouth completely sore, and, as he 
was much reduced in strength, that his constitution 
should be supported with light nourishing food. 

As he lived at a considerable distance I did not ex- 
pect to see him again, neither did I hear any thing of 
him till the month of February thereafter when I was 
again desired to visit him. A considerable change had 
taken place in the nature of his complaints, and the 
following is the account which I received of it. His 
mouth had been rendered moderately sore with mer- 
cury, and in this situation it was kept for three weeks ; 
but as it then gave him severe pains in his bowels, ac- 
companied with purging, he did not afterwards use it 
in such quantities, nor was it judged necessary to do 
so, as the swelling, for which it was prescribed, was 
almost entirely carried off by what had already been 
done. It was therefore given in such quantities, as his 
stomach and bowels could easily bear ; and this being 
continued for the space of a month longer, that is, for 
six or seven weeks in all, it was then left off. During 
this course of mercury the pains which had so long dis- 
tressed him were much less severe, and at one period 
they had left him almost entirely. While the weather 
continued mild in summer and harvest they did not re- 
cur ; but about the end of October they became more 
severe than they had ever before been. A few weeks, 



30tf OF LUES VENEREA Oil. IV. 

however, previous to this, symptoms of a more hazard- 
pus nature had made their appearance. In the month 
of September he was attacked with anasarcous swell- 
ings of his legs, and soon thereafter with ascites, which, 
notwithstanding the usual remedies employed in sucli 
cases, increased so quickly, that in the course of seven 
or eight weeks from the first approach of the swelling, 
it became necessary to draw the water off from the legs 
by punctures ; and by the middle of December the 
distension of the abdomen was so considerable that the 
operation of tapping was judged adviseable. These 
operations, however, had procured only a temporary 
relief, for although the punctures had been frequently 
repeated, his legs, at the time of my being called to 
him, were much swelled, and his abdomen was more 
distended than at any period before the operation. 

The chief reason, however, of my advice being ta- 
ken at this time, was the appearance of some hard pain-, 
ful tumours upon his forehead, legs, and arms, one of 
which upon his right arm on the outside of the ulna, 
and another on the upper part of the os frontis, had 
burst some weeks before, and were now discharging a 
considerable quantity of a thin foetid matter. The 
others, viz. two upon his forehead, one upon his left 
arm, and one upon each leg were become very painful, 
and those on the head were discoloured, and contained 
such a quantity of matter as gave reason to think that 
they would also burst. The patient was at this time 
much emaciated, but he had no fever, and bis skin 
was softer and his discharge of urine more plentiful 
than they generally are in dropsical complaints. 

As the tumours resembled venereal nodes, and as 
the peculiar fetor of the discharge from the ulcers, to- 
gether with their sloughy appearance, gave farther 
cause of suspicion, I found, upon enquiry, that in Sep- 
tember 1731, about six months before he was attacked 
with rheumatism, chancres appeared upon his penis, 
and a bubo in each groin, but that these symptoms 
were easily removed by the use of a small quantity of 
mercury, and a short confinement of eight or ten days, 
and that he had not since that period run any risk of 



SeC. IX. AS INDUCING OTHER DISEASES. 303 

being infected ; that no other symptoms of the disease 
had appeared upon him, and that the only mercury he 
had used was that which was prescribed for the affec* 
tion of his liver. 

I now began to suspect even that the rheumatism 
with which he had so long been distressed was of the 
syphilitic kind, and my reasons for doing so were ap- 
parently conclusive. There was full evidence of in- 
fection being communicated while it did not appear 
that he had taken half the quantity of mercury which 
the nature of the symptoms that ensued would have re- 
quired. These pains occurred at such a distance from 
the other symptoms as tended to confirm the suspicion. 
They had not been relieved by any of the remedies 
which in the ordinary form of rheumatism prove for 
the most part useful, while they were for some time 
almost entirely removed by the mercury employed for 
the diseased state of his liver. These considerations, 
connected with the present appearances of the tumours 
and ulcers, determined me to say that he was poxed* 
and that he should begin to the use of such a quantity 
of mercury as his present situation would admit imme- 
diately upon the water in his abdomen being taken off, 
and which was done that ver> 7 day. 

Being afraid in his present state of debility of irri- 
tating his bowels by the internal exhibition of mercu- 
ry, he was desired to use it in the form of unction on- 
ly; and his legs being still much swelled and tender, 
he was made to rub it upon his arms and abdomen. In 
the course of a few days his mouth became sore, and 
at the end of a fortnight he discharged three or four 
English pints of saliva daily. This was more than we 
wished for, and he Was desired to lessen the quantity 
of mercury ; but as his pains were soon almost entire- 
ly removed, and the distress which he had experienced 
from the tumours and ulcers being also much lessened, 
he was thereby so much convinced of the propriety of 
his present treatment that it was with some difficulty 
he was prevented from carrying the course of mercury 
too far. Care, however, being taken, to support him 
with a light nourishing diet, and with a liberal use of 



304 OF LUES VENEREA Cil. IV 

wine, of which he took a bottle daily, he was enabled 
to bear the effects of mercury better than one in his 
state of health might otherwise have been expected to 
do. At the end of eight weeks, during which period 
his mouth had been kept constantly and fully affected, 
he had used twelve ounces of slrong mercurial oint- 
ment. His pains were now entirely gone; the ulcers 
were cicatrised ; and the tumours were so completely 
removed, that excepting those on the fore part of the 
legs, none of them had left any fulness by which their 
former situations could be discovered. The matter 
contained in those upon the foiehead, and which at 
one period was just ready to burst out, was entirely 
absorbed, and only a slight discolouring of the skin 
remained ; but what was still more remarkable, no 
swelling had as yet occurred in the abdomen, and the 
anasarcous fulness of his legs and thighs was almost 
entirely gone, although the punctures last made in 
them had been healed upwards of three weeks. The 
mercury was continued for five weeks longer, during 
which period four ounces of ointment was rubbed in, 
by .which the mouth was kept as sore as the patient 
could possibly bear it; and when at the end of the 
thirteenth week the mercury was left off no collection 
could be perceived in the abdomen ; and excepting a 
slight degree of oedema on the upper part of the feet, 
they were altogether free of swelling. Even this dis- 
appeared in the course of a few weeks ; and at the 
end of three years, when I had last an opportunity of 
hearing of him, he remained in good health. 

The circumstances of this case, while they give 
much cause to think that hydropic symptoms may be 
induced by the virus of Lues Venerea, tend also to 
shew that mercury given in sufficient quantity acts 
with equal certainty in removing them as in the cure 
of any symptom of the disease. They also evince the 
power of mercury in the cure of that affection of the 
liver to which many are liable who have resided in 
the East Indies; and that even the most advanced sta- 
ges of that disorder may be removed by a quantity of 
mercury that will not be sufficient for the cure of 



Sec. IX. AS INDUCING OTHER DISEASES. 305 

Lues Venerea. It also appears, from the result of 
this case, that the matter which sometimes forms in 
venereal nodes may be collected in considerable quan- 
tity, and yet carried off by mercery. Tt may be pro- 
per, however, to remark, that where this takes place 
the tumours in which the matter is contained begin to 
diminish almost as soon as there is evidence of the 
mercury having entered the system ; and that when 
they do not diminish the? matter should be discharged 
by a proper opening, in order to prevent it from af- 
fecting the bone beneath. 

About two years ago I was desired by a gentleman 
to visit his wife, who I found had been liable for more 
than a year to what she considered as scorbutic spots 
upon different parts of her body, one of which, seat- 
ed on the sternum, had about three months before 
ended in an ulcer. At first the sore did not exceed 
the size of a sixpenny piece ; but at this time it was 
very extensive, reaching from one mamma to the 
other, and almost from the inferior point of the ster- 
num to the top of it. It was foul, and discharged a 
thin foetid sanies. For upwards of three years she had 
been distressed with almost a constant head-ach, which 
occasionally was so severe as to deprive her entirely 
of sleep for many days together, and on some occa- 
sions nearly of her reason. It did not, like the aguish 
bead-aeh, fix upon one spot, but affected every part of 
the head alike. She was now about thirty years of 
age, and her menstrual flux regular. Till attacked 
with these head-achs she was healthy and rather cor- 
pulent; but now she was much reduced, being almost 
entirely confined to bed with the violence of the pain, 
and she had scarcely any desire for food. Blood-letting, 
blisters, bark, cold-bathing, and a variety of nervous 
r:x dicines, had all been tried in vain. 

The eruption upon the skin, as well as the ulcer on 
the breast, having the true venereal aspect, I enquired 
of the husband whether he had of late been infected 
ormot: He said that he had not, but he candidly in- 
formed me, that soon after his marriage, which hap- 
pened more than four years before, and when he had 

vol. m 39 



i306- q$ LUES VENEREA Ch. IV. 

no reason to think that he was infected, for he had no 
connection with any woman for a fortnight before* 
marriage, and after having remained well for a fort- 
night thereafter, a ehAncre had appeared upon the pre- 
putium. Immediately upon this being perceived he 
applied to a surgeon and was cured ; and he had eve- 
ry reason to think thai his wife had escaped; for al- 
though she had complained of a soreness in the puden- 
dum about the same period, it had gone so entirely off 
without any mercury being given, that the surgeon, 
"by whose advice he was directed, had assured him, it 
must have proceeded from some other cause. He also 
recollected that soon thereafter a painful tumour had 
formed in one of her groins; but as it also went off 
without coming to suppuration, and without the assist- 
ance of mercury, he had supposed even that this 
symptom could not be venereal, particularly as she con- 
tinued in perfect health till attacked with the head-ach ; 
and no symptom of pox had ever appeared upon her, 
unless the eruption and ulcer already described should 
be of tli at nature. 

From the whole of this history, the probability of 
the wife being infected with the venereal disease, and 
the necessity of a mercurial course were abundantly 
evident. Mercury was accordingly exhibited. Opi- 
um, which she had hitherto employed for lessening 
the violence of her head-ach was continued, while the 
sore was dressed with common wax ointment. Her 
mouth became sore in the course of a few days, and 
before the end of a fortnight she was under some de- 
gree of salivation. The eruption soon began to les- 
sen, and the sore from being exceedingly foul became 
dean and florid, at the same time that the head-aehs, 
for which no cure was expected, left her entirely ; the 
mouth was kept completely affected; the blotches dis- 
appeared altogether in the course of six or seven 
weeks, but the ulcer was not cicatrised till the end of 
the eleventh week. The mercury being continued 
three weeks longer was then laid aside, and neither the 
head-ach or other symptoms have since recurred. 



Sec. XX. AS INDUCING OTHER DISEASES. &07 

In the month of July 1781 a young nian about 
seventeen years of age was put under my care in a 
very miserable situation. The account which I re- 
ceived from his parents was, that till his fourteenth 
year he was remarkably strong and healthy, and ex- 
ceedingly clever. About that period he became deli- 
cate, and was taken from school, in order to have full 
attention paid to his health. Worms, and a variety of 
other causes were suspected to give rise to this state of 
delicacy, and various remedies were employed without 
effect, when after two years had nearly elapsed sores 
appeared on different parts of his body ; his eyes be- 
came tender and inflamed, and at last he lost the use 
of one eye entirely, and about a year before I saw 
him he had been attacked with severe fits of epilepsy, 
which for the last two months had recurred several 
times a- day. He was now much emaciated, but his 
pulse w 7 as good, and the fits had not impaired his 
judgment. 

Till this time he had been under the management of 
a physician, a relation of his own, who considering the 
complaint to be scrophulous, had prescribed bark, steel, 
cicuta, and sea-bathing ; all of which; as well as differ- 
ent remedies for the epileptic fits, having been tried in 
vain, all hopes of a cure were lost, arid for a long 
while nothing had been employed. My opinion was 
asked on account of the ulcers, some of which had of 
late become so painful that large doses of laudanum 
were required to procure rest. Besides several small 
ulcerated spots, there wasat this time seven large foul 
ulcers on different parts of his body, none of which 
had given him much uneasiness while not deeper than 
the cellular substance ; but having in different parts 
penetrated into the substance of muscles, they began 
now to impede the motion of the parts on which they 
were seated, which added much to the distress which 
they excited. His left eye exhibited a very singular 
appearance. It was somewhat enlarged, and that part 
of the tunica conjunctiva, which in a state of health is 
white, was of a deep red colour, while all the promi- 
nent part of the cornea opposite to the pupil was much 



303 OF LUES TO ERE A CI). IV, 

thickened, and white like paper. He still retained the 
sight of his right eye, which, however, was much in* 
flamed, and in a state of great irritability. 

As the ulcers had a venereal appearance, particu- 
larly one upon the right side of his nose, and another 
on one of his temples, where it had penetrated to the 
muscle, I said so to the young man himself, and he 
confessed that he had all along been afraid of his dis- 
ease being of that nature, but not being certain of this 
being the case, and afraid of incurring the displeasure 
of his parents, he had never till now, that inquiry was 
made concerning it, had the resolution to speak of it. 
The information he gave me was, that when he was 
about fourteen years of age he was infected by a wo- 
man with whom he had connection, and that his symp- 
toms had been sores upon the penis and a swelling in 
the groin. These, by the use of mercury, which he. 
received from a young man, at that time a student in 
the university, were removed ; but as he had not taken 
it in a regular manner, and only in small quantity, he 
had always entertained suspicions of the symptoms 
which ensued being the consequence of this infection. 
J now decidedly said that he ought immediately to 
take mercury, and he entered upon the use of it that 
very evening. It was employed in the form of unc- 
tion, and all the sores, excepting that upon his nose, 
were dressed with common cerate, the only applica- 
tion which he had hitherto made to them. As the ul- 
cer upon his nose had already begun to disfigure his 
fate, I advised it to be touched with caustic every se- 
cond or third day, in order to stop the progress of the 
disease as quickly as possible, and besides this it was 
dressed with basilicon and precipitate. As the mer- 
cury did not readily affect his gums 'he was desired to 
take two of the blue pills every night at bed-time, and 
to continue to rub in the same quantity of ointment 
which he had used from the first, viz. a drachm evening, 
and morning. In the space of three weeks from the 
commencement of the course a considerable salivation 
was induced, which was afterwards kept up by the 
unction alone till the end of the fifteenth week, The 



SeC. IX. AS INDUCING OTHER DISEASES, 309 

ulcers bad become clean, and put on a healing appear- 
ance soon after the mouth became sore, and by the 
end of the ninth week they were all cicatrised ; but 
the infection having been of very long duration, and 
the symptoms more inveterate than usual, I did not 
think it proper to advise the use of mercury to be 
sooner left off. 

The most remarkable circumstance, however, in this 
case was, the cure which took place during the course 
of mercury of the fits of epilepsy. In less than three 
weeks they became less frequent, and not so violent as 
they had been before, and by the end of the sixth 
week they did not recur above once in three or four 
days. Long before the course was finished they van- 
ished entirely, nor was he ever distressed with them 
afterwards. His left eye still continued white and 
opake, but the inflammation of the other being remov- 
ed, he soon recovered the free power of vision of which 
he had long been entirely deprived. 

A married lady, twenty-six years of age, after being 
for some time distressed with severe head-achs, was 
attacked with epileptic fits, which at first were neither 
frequent nor severe, but recurred at last so often ti at 
she was commonly seized with three, four, or even 
more, daily. Preparations of copper and other reme- 
dies were employed without effect. In other respects 
her health was good, till at last, after the fits had been 
more than usually severe for eight or ten days, she 
became suddenly lunatic, from which time the epilepsy 
did not recur. 

In this situation she was kept at home for three or 
four months, but there being no prospect x>f her re- 
covering, she was at last put under the care of a fami- 
ly accustomed to take charge of lunatics. As her 
keepers were desired to apply to me in the event of 
her health requiring any particular attention, I was 
called to her after she had remained with them about 
two years, in order to give directions for the manage- 
ment of some sores which had appeared in different 
parts of her body a considerable time before. Besides 
several small foul ulcers upon her toes and feet, there 



310 OF LUES VENEREA (Jil. J$* 

was a large one upon the wrist of her right arm; one 
upon her side, which had penetrated nearly to the ribs r 
and two upon the upper and back part of her head, 
where the cranium was found to be carious. These 
ulcers, they informed me, were preceded by an erup- 
tion, which the}' considered to be scorbutic, but which 
I found upon inspection to be venereal. On this being 
stated to her husband, he acknowledged that she might 
have been infected by him, but as she had never com 
plained of any of the symptoms of Lues Venerea, he 
bad hoped that she had escaped. 

A course of mercury was advised, but as her lunacy 
■Was of the most unmanageable kind, she could not be 
made either to take the medicine inwardly, or to ad- 
mit of the external application by unction* The latter 
might have been done by force, but the trouble of se- 
curing her twice a-day for that purpose would have 
been considerable. 

Finding that she was fond of oatmeal porridge, she 
Was allowed to take them both to breakfast and sup- 
per, and with each meal her keeper was desired to 
mix a spoonful of a watry solution of corrosive subli- 
mate, in which was contained three quarters of a grain 
of this preparation. No obvious effect appeared from 
it till nearly the end of the third week, when her 
breath became affected, and her gums sore and spon- 
gy ; but although the same quantity of mercury was 
continued, no salivation took place. Simple dressings 
were applied to the sores. It became necessary, how- 
ever, to make an incision along a considerable part of 
the left parietal bone, in order to discharge a quantity 
of foetid matter which had lodged between the tegu- 
ments and a portion of that bone which was carious; 
All ttie rest oi the sores soon put on a healing appear- 
ance. In the course of nine weeks they were com- 
pletely healed, and during this period the maniacal 
symptoms also abated. In less than three weeks from 
the above period she became perfectly well, and no ap- 
pearance of lunacy has since taken place, although 
several years have elapsed. The sore upon the left 
side of the head continued open for eight or nine 



SeC. IX. AS INDUCING OTHER DISEASES. 311 

months after the mercurial course was finished, owing 
to an extensive exfoliation from the parietal bone, 
which could not possibly be accomplished sooner. 

These, as I have already observed, are only a few 
of a considerable number of cases of a similar nature 
which I might relate; but as the evidence which these 
afford, of the opinions which I have suggested being 
well founded, may be considered as sufficient; any 
farther argument would be unnecessary. The histo- 
ries which I have given are in proof, that the syphili- 
tic virus may remain for a great length of time in the 
system, without producing any of the ordinary symp- 
toms of Lues Venerea: That other diseases altogether 
different from Lues Venerea in the form under which 
it usually appears, are, in some instances, induced by 
this virus. That the quantity of mercury commonly 
given in what is termed an alterative course may be 
sufficient for curing the existing symptoms of Lues 
Venerea, and yet altogether inadequate, however long 
continued, for removing the disposition, And lastly, 
although a course of the alterative kind may repeated- 
ly fail, that the syphilitic disposition, as well as the 
worst symptoms of the disease, may be removed by 
■the proper exhibition of a full quantity of mercury. 



As a Supplement to this section, we intended to give an analysis 
of the works which of late years have been published on Diseases 
resembling syphilis, or more properly, on those complaints which 
originate either from an improper administration of the specific, 
from a failure in eradicating the virus of the disease, or from both 
combined. After however attentively perusing the writings of Aber- 
netlvy, Mathias, Sec. we have found the subject treated so exten- 
sively, and the opinions of surgeons so diversified, that it would be 
difficult to include a complete analysis within the compass of a few 
pages. The sterling merit of the above writers entitle them to a 
distinct perusal, and the reader will find much information both in 
the reasoning and cases of each. — The following works are among 
the most important. 

Abernethy's Surgical Observations on Diseases resembling Sy- 
philis. Philadelphia. 1811. 

Mathias on the Mercurial Disease. 

Hunter's Chapter on Diseases resembling Lues, 



312 OF LtfES VENEREA, &C. Cll. IV. 

Pearson, 2nd Edit. This distinguished Surgeon styles the dis- 
ease Cachexia Syfihiloidea. 

Remarks on Diseases resembling Syphilis by Dr. Channing of 
Boston, in the New-England Journal, Vol. I. — together with Re- 
views of Abernethy and Mathias, in the London Medical Review? 
* r oL 3rd, Ep< 



APPENDIX 




THIS Appendix contains formulae of injections and other reme- 
dies for Gonorrhoea, enumerated in the preceding work. 

No. 1. R. Calomel, pptt. 5 ii. 

Mucilag. gum, arab, 5 ii' et adde. 
Aq. rosar. ? iv. 

No. 2. R. Calomel, pptt £ ii. 
Balsam, copaib. £ i. 
Vitell. ovi. 5 ss. M. et adde paulatim. 
Aq. rosar. 5 iv. 

No. 3. R. Hydrargyr. puris. £ ii- 

Mucilag-. arab. 5 ii. M, S. A. et adde. 
Aq. distillat. 5 iv. 

These formulae of mercurial injections seem to act, as I have else- 
where observed, altogether as astringents. They excite little or no 
irritation and when they prove successful they commonly do so in 
the space of a day or two. In all of them the mixture requires to 
be shaked when used ; for even with the assistance of mucilage the 
mercury subsides so quickly that scarcely any of it will enter the 
syringe, if this precaution be omitted. 

Instead of mucilage, prescribed in No. 3, I have sometimes em- 
ployed honey. This proves more expeditious for extinguishing the 
mercury, but the injection prepared with it excites more pain. 
Whether mucilage or honey be employed, the mercury should be 
very completely tritured. 

No. 4. R. Lap. calamin. pptt. 3 "* 
Balsam, copaib. £ i. 
Mucilag. arab. 5 ii. M. S. A. et adde- 
Aq. fontan. 5 iv. 

No. 5. R. Lap. tutije pptt. £ ii. 

Mucilag. arab. 5 ii- M. et adde 
Aq. fontan. 5 iv. 

No. 6. R. Lap. calam. pptt. 5 iv. 

Camphor, in pauxil. spirit, vin. rect. solut. ? i. 
Mucilag. arab. 5 iv. M. et adde aq. fontan, lb. vl, 
Ut fmt injectio, 
VOL. II. 40 



314 APPENDIX. 

In No. 4,the quantity of the astringent earth is so small that it may- 
be well mixed with the liquid at the time of using it, but in Nos. 5 
and 6, where there is a greater proportion of earth, after shaking 
the phial, it. should be allowed to subside for the space of a minute 
before filling the syringe. In this manner the finer particles only of 
the earth are thrown into the urethra; and it commcnly proves as 
effectual as when the whole of it is used. 

No. 7- R- Alumin, 2> iss. 

Solve in aq. distillat. 5 viii. 

No. 8. R. Cortic. quercus ? i- 

Coq. in aq. fontan. 5 xx. ad. 5 xvi. colatura: adde. 
Pulv. alumin. 5 ii- 

No. 9. R. Gall, quercus contus. 5 i- 

Coq. in aq. fontan. 5 xxx. ad. ± xx. cola et adde. 
Pulv. Alumin. ^ Ui- 

No. 10. R. Kin. pulv. 3 ii. 

Mucilag-. arab. 5 i. M. in mortario et adde aq. fontan. bul. "Z 1 

No. 11. R. Kin. pulv. 5 ii. 

Pulv. alumin. 3 i- 

Opii. 9 ii. 

Mucilag". arab. 5 i- M. et adde. 

Aq. fontan. bul. 5 x. 

No. 12. R. Opii. J i. solve in aq. font. 5 vi. 

No. 13. R. Aq. rosar. $ vii. ss. 

Tinctur. thebaic. J ss. M 

In a great proportion of cases opium dissolved in water answers 
the purpose ; but in a few instances I have found the spirituous tine 
ture, in the proportions here mentioned, prove more effectual. 

No 14. R. Balsam, canadens- 
Vel. copaib. 3 i»- 
Vitell. ovi. 5 ss. M. et adde. 
Aq. rosar. 5 vi. 

When the balsam and yolk of an e^^ are previously well rubbed 
together, the water may be mixed with them so completely that no 
great degree of separation will afterwards take place ; but to pre- 
vent any inconvenience which might ensue from the balsam getting 
to the top of the mixture, it should always be well shaked imme- 
diately before the syringe is filled with it. 

JS T o. 15. R. Ceruss. 3 ii. 

Mucilag. arab. ? ii. M. et adde. 
Aq. fontan. distil. 5 vi 



APPENDIX. 3 1 5 

No. 16. R. Sacch, saturni. 9 »» 

Solve ill aq. distil. jr viil 

No. 17. Aq. distil. 5 viii. 

Acet. lythargyr. gutt. xxiv. M. 

When saccharum saturni, or cerussa acetata, as it is now termed} 
can be obtained pure, it is perhaps preferable for every purpose to 
vinegar of litharge, as being of a more determined strength ; but 
it is frequently so much adulterated that it will not dissolve but in 
very small quantities, even in distilled water. Some of it indeed is 
so very insoluble, that an ounce of water will not dissolve above a 
grain of it. By the addition of vinegar this may, it is true, be part- 
ly remedied ; but vinegar, for many purposes, is not admissible in 
such quantities as would be necessary for rendering this article 
much more soluble than we usually find it. Two, three, or more 
drops of the vinegar of litharge may be used in every ounce of in- 
jection. Two drops often prove sufficient, but many can bear eight 
or ten. 

The following method of preparing vinegar of litharge is the 
best I have met with. It is not very different from the extract of 
lead of Goulard, but the strength of it is more certain, 

R. Lythargyri J-j^ iii. 

Acet. distillat. fe x. coq. leni igne ad. fe vi 
Cola. 

Besides boiling on a slow fire, during which time it ought to be well 
stirred with a wooden spatula, the whole should be allowed to cool, 
and the faeces to subside before straining. 

Lead dissolved in this manner is easily mixed with water, and it 
proves to be a very convenient, as well as a very effectual method 
of using it. 

No. 18. R. Zinci vitriolat. vul^o vitriol, alb, X ss. 

. "-' 

Solve in aq. font, distillat. ^ xvi. 

No. 19. R. Zinci vitriolat. ►) i. 

Solve in aq. distillat. *z x. et adde. 
Acet. lythargyri gutt. xx. ut. f. mjectio. 

In some cases, where these articles have excited pain when used 
in this manner, they have been rendered perfectly mild by the addi- 
tion of mucilage of gum arabic, and in others by camphor. Cam- 
phor does not dissolve completely in any watery fluid, but being 
previously well rubbed with a few drops of spirit of wine, as much 
of it may be mixed with the water as to render the other articles 
much less pungent than they otherwise would be. The camphor, 
however, separates in such quantities as renders it necessary to fil- 
ter the solution before using it. 



316 APPENDIX. 

Although a precipitation necessarily takes place from a mixture 
of vitriol and saccharum saturni, the following combination of these 
two articles with opium gives a very useful form of injection. 

No. 20. R. Vitriol, alb. 

Sacchari saturni. afi ^ ss. 

Camphor, J *■ 

Opii. 9 ii. 

Solv. in aq. fontan. bul. ? x\ i 

Cola. 

Ko. 21. R. Fol. rosar. rub. ? ss. 

Alumin. pur. X ii. infund. in aq. bill. ± xvi. Cola. ut. f. in- 
jectio. 

No. 22. R. Balsam copaib. 

Vitell. ovi. aa 5 ss. M. et adde. 
Infus. rosar. rubr. 5 xvi. 

No. 23. R. Cap. papaver. alb. $ iv. 
Rad. altheac incis. 5 i- 
Infund. per noctem in aq. bul. fe ii 
Cola, 

No. 24. R. Hydrargyr. muriat. vplg. mercur. sublimai. corrosiv. gr. 1 
Solve in aq. fontan. 5 x. 

No. 25. R. Mercur. sublim. corros. gr. 1. 
Acet. lythargyr. girtt. xvi. 
Aq. fontan. $ viii. M. S. A. 

No. 26. Mercur. sublimat. corros. gr. 1. 

Mucilag. arab. ± ii. 
Aq. fontan. ^ vi. M, 

Corrosive sublirnate dissolved in water proves to be the most cei^ 
tain, and perhaps in every respect the best form of a stimulating- 
injection. Some have advised a much stronger solution than any of 
these, even to the extent of a grain of mercury to three or four 
ounces of water. I suspect, however, that those who recommend 
it of this strength have never made use of it, at least I have never 
met with any who could bear it. When the mercury is combined 
with water alone, as in No. 24. one grain to ten ounces proves suffi- 
ciently strong; but when mixed with saccharum saturni, with ace- 
turn lythargyri, or with mucilage, as in Nos 25. and 26. a grain 
may be added to six or eight ounces of water. When mixed with 
either of the two first of these articles, some part of the mercury 
precipitates, and is therefore lost, and in the other the mucilage 
tends evidently to render it less active. 

No. 27, R. Sal. aramon. crud. gr. x. 
Solve in aq. font, g x, 



APPENDIX, 317 

No. 23. R. Aq. fontan. ~ x. 

Spirit sal. aromat. gatt. lx. M. 

No. 29. R. Aq. fontan. 3 x. 

Spirit corn, cervi gutt. lx. M. 

No. 30. R. Formul. inject. No. 23. § viii. 
Lixiv. caustic, gutt. xx. M. 

I have frequently found both the volatile and caustic alkali prove 
useful where other injections had failed, but we cannot with any cer- 
tainty point out the strength for any individual. While one is able 
to bear ten drops to every ounce of water, others cannot bear above 
three or four: The strength I have advised in the three preceding 
formulae proves to be the best for general use, but patients are more 
easily affected with variety in the strength of these injections than 
of any other I have ever tried. The caustic alkali may be used in 
water alone ; but may be ventured upon in larger quantities, and 
with more safety, when combined with a mucilaginous infusion. 

No. 31. R. iErug. pptt. gr. viii. 
01. oliv. Opt. I iv. M. 

No. 32. R. JErug. pptt. 5 i. 

Spirit, corn. eery. 5 iv. 
Digere et cola. 

R. Solut. supr. parat. gutt. xl. 
Aq. distillat. § x. M. 

Verdigris mixed with oil may be used with perfect safety of the 
strength mentioned in No. 31, but as injections prepared with oil 
prove dirty and disagreeable in the application, I commonly prefer 
the form of the remedy No. 32. 

A much larger proportion of verdigris is commonly advised, but 
when more is employed, it precipitates immediately on being adcied 
to the water. Even of this strength the precipitation cannot be pre- 
vented entirely but by adding about a half more of the volatile al Ka- 
li to the filtered solution of the verdigris. After filirating through 
paper, if two ounces of volatile alkaii be added to it, no precipita- 
tion will take place if distilled water is employed ; but in this case, 
a greater quantity of the solution may be added to the same quantity 
of water. Instead of forty drops, forty-eight or fifty may be added 
to ten ounces of water. 

No. 53. R. Aq. fontan. ~ x. 

Tinctur. caiuliarid. gutt. xx. ad xxx. M. 

The three following are prescriptions for bougies. 

No. 34. R. Emplast. diachyl. siffipl. 5 iv. 
Cer. punss. 5 iss. 
Ol, oliv. opt. Z iii, 



318 APPENDIX. 

No. 35. R. Emplast. commun. 

Spermat. est. aa § iv. 
01. oliv. opt. ^ ss. 
Minii. § ss. M 

No. 36. R. Emplast. commun. £ vi. 
Cerae flavae puriss. 
Spermat. cxt. aa § ii. 
01. oliv. opt. § i. 
Antimon. crud. pptt. £ ss. M. S. A. 

Any of these prescriptions afford a good composition for bougies. 
They require to be slowly melted, and the different articles to be 
well mixed together. No. 34. is the simplest and perhaps the best, 
the red lead in No. 35. and antimony in No. 36. being added chiefly 
for the purpose of affording variety of colour. No. 37. is a com- 
position for bougies recommended by Mr. John Hunter,* and No. 
38. by Mr. Sharp.f 

No. 37. Take oil of olives three pints, Bees wax one pound, Red lead a 
pound and a half. Let them be boiled together on a slow fire 
for six hours. 

No. 38. R. Diachyl. cum pice burgund. § ii. 
Argent, viv. § i. 
Antimon. crud. pptt. g ss. 

The quicksilver to be previously dissolved in balsam of sulphur, 
or in honey, and added to the plaster when melted in a moderate heat. 

Any of these compositions, when boiled to a proper consistence, 
will answer for the formation of bougies, which is done in the fol- 
lowing manner: While the liquid still continues warm, let a piece 
of fine old linen be dipped in it, taking care with a spatula to cover 
the whole of it. If the melted liquor be of a proper heat, no more 
of the plaster will adhere to the linen than is necessary; but as air 
bubbles are apt to rise and produce inequalities on the surface of 
the cloth, the spatula made use of should be somewhat warmer than 
the plaster, and by means of it the whole should be made as smooth 
tts possible. The plaster might indeed be spread entirely with the 
spatula ; but this is not only attended with more trouble, but it does 
not cover the cloth with sufficient equality. 

The cloth being sufficiently cold, may be immediately formed in- 
to bougies, and the whole should, in the first place, be cut into the 
number that is meant to be made. The most exact method of doing 
this is by means of a sharp pointed knife directed by a rule. The 
pieces should be eleven inches in length for bougies of a full size ; 
but they should likewise be kept of all the variety of lengths for 
strictures of different heights in the urethra. 

* See Treatise on the Venereal Disease, p. 137. 

f See Critical Enquiry by Samuel Sharp, F. R. S. &c. 



APPENDIX. 319 

A variety of directions have been given for the form of bougies, 
Some advise them to be made nearly of an equal thickness to within 
an inch of their smallest end, and to taper from that to the point, 
while a great proportion of them are made to taper to within an 
inch or two of the point, and the rest of them are cylindrical. I 
once thought that this last form of bougie was the best ; but after a 
long course of experience in this branch of business, I am now con- 
vinced, that bougies, which taper equally from one end to the oth- 
er, are the best, and that this form answers equally well for every 
variety of size. They are introduced more easily, and with less pain 
than any of the others ; the linen should therefore be cut in such a 
manner as to give this form to the bougies. When rightly spread, 
and the linen sufficiently fine, a well shaped bougie will be formed 
of a slip of about five eighths of an inch broad at its largest end, 
and somewhat more than three eighths at the smallest end. This 
forms a bougie of a middle size ; for particular purposes they must 
be considerably larger, and for others not so large by a great deal. 

These slips of linen are now to be rolled up as neatly as possible 
with the fingers ; and in order to give them a smooth polished sur- 
face, they should be smartly rolled between a piece of smooth hard 
timber, and a plate of fine polished marble : This being continued 
till the whole are rendered perfectly smooth and firm, and their 
points being properly rounded in order to facilitate their introduc- 
tion, they are in this state to be kept for use. 

These directions will convey an idea of the method of preparing 
bougies, but no surgeon can ever become so expert in forming them 
as those artists who are daily accustomed to prepare them in large 
quantities. I must here again observe, however, in addition to 
what I had occasion to remark in a former part of this work, that 
bougies, properly prepared with resina elastica, are preferable, in 
many circumstances, to such as are made with any kind of plaster. 
They not only prove much more durable, but more force can be em- 
ployed with them, and as they do not break or crack by remaining in 
the urethra, they remain in it with less pain and inconvenience than 
any other bougie that has yet been invented. 

Cat-gut has frequently been used as a bougie; but after various 
trials being given to it, I do not find that it answers the purpose : It 
cannot be made sufficiently smooth, and it sometimes swells so 
much as to excite a good deal of irritation ; and lead, which was 
one of the first articles used for bougies, is so firm that it always 
creates much pain, while at the same time it is so apt to break that 
different instances having occurred of this happening in the urethra, 
it has now been long laid aside. 

The six following prescriptions are meant for the removal cf warts 
and other excrescences, and they answer equally well whether they 
proceed from Gonorrhoea or Lues Venerea. It would appear, how- 
ever, that there is a material difference between the warty excres 
cences which occur as a consequence of these diseases, and such a? 



320 APPENDIX. 

we usually meet with from other causes; for while the former arc 
for the most part easily removed by any of these applications, even 
by the pulvis sabinae alone, the latter are seldom acted upon by any 
of them, if it be not by the strong solution of corrosive sublimate 
in No. 40. and of mercury and spirit of nitre, No. 41. both of which 
are possessed of a strong degree of causticity. 

No. 39. R. Sal-arhmon. crud. 5 i- 

Solve in acet. distillat. ? ii. 
Aq. fontan. § iv. 

No. 40. R. Hydrargyr muriat. vulgo. mere, sublim. corros^ 
Sal-ammon. crud. aa % ss. 
Solve in aq. fontan. ^ iv. 

No. 41. R. Argent, viv. ? i. 

Solve in spirit, nitr. fort. oz. ii. 

No. 42. R. Pulv. fol. sabin. 

Calomel, aa 5" i. M. 

No. 43. R. Pulv. fol. sabin. 

Mercur. sublim. corros. aa £ *&-■ 
Mercur. precip. rub. ^ i- M. 

No. 44. R. Alumin. ust. 

Mercur. precip. rub. aa ^ i. M. 

The following form of decoction of sarsaparilla and mezereon is 
of a strength which most people can bear ; when a greater propor- 
tion of mezereon is added, it excites sickness, and a very disagree- 
able sensation in the throat. I mention it here as I have had occasion 
to speak of it in the preceding work ; and I shall also have cause to 
refer to it when treating of Lues Venerea. 

No. 45. R. Rad. sarsa. 3* ii. 

Cortic. radic. mezer. ^ i ss - 
Coq. in aq. fontan. lb. iii. ad. lb. ii 
Colaturae, adde. 
Syrup, althese 3 i. 

The following is the Decoctum Lusitanicum, or Lisbon dirt-drink 

No. 46. R. Rad. sarsapariL 
Santal. alb. 

Rubr. aa. 5 iii. 
Rad. glycyrhiz. 

Mezerei. aa. oz. ss 
Ligni rhodii. 

Guaiaci. 

Sassafras, aa. 0/ i 



APPENDIX. 321 

Antimoiv cmd. 5 ii. misce, et infunde in aqua: fontanae bill- 
lientis. lb. x. per horas xxiv. dxen, coque ad lb. v. cola^ 
turx capiat, a lb. iss. ad. lb. iv. quotidie. 
Vel R. Rad. sarsaparillae. " 

Ligni sassafras. 

Ligni santal. rubri. 
Guaiaci aa. 

Cortic. rad. mezer. 

Semin. coriand. ^ Vi7 

Coq. in aq. fontan. lb. xx. ad. lb. x. 

Sumat lb. ss. ter quaterve indies. 

Unguentum e calce zinci. 

No. 47. R. Olei olivarum opt, 5 iiL 
Cerae albae. 

Sperm, cetae aa. J m - 
Leni calore liquesc. dein adde. florum zinci 5 ss. 

Unguentum e lafiide calaminare, 

No. 48. R. Olei oliv. opt. ^ iii. 
Cerae albs. 5 iss. 
Sperm, ceti. 5 ss. 
Lapid. calamin. pptt. J v. M. S. A, 



VOL. II. 

THE following Appendix contains formulas of all the medicines 
erurnevated in the second volume, as well as of some others occa- 
sionally employed by other practitioners in the cure of Lues Vene- 
rea. 

No. 1. Emfilastrum hydrargyri,vulgo,Emfilastrum c<eruleum, 
■vel met * curia Le. Pn. Edin. 

R. Olei olivarum. 

Resins albae utriusque partem unam, 
Hydrargyri partes tres. 
Emplastri lythargyri partes sex, 

Cum oleo et resina, liquefactis simul, et dein refrigeratis, teratur hydrargyrus, 
donee evanescent globuli ; turn paulatim addatur emplastrum lythargyri liquet 
factum, et omnia accurate iaisceantur. 

tojl. m 41 



322 APPENDIX. 

Unguentum fiydrar gyri fortius, -outgo* Unguentum mercuriale* 
Pharm. Lond. 

No. 2. Hydrargyr. purif. P. libras duas. 

Adipis suilix preparatae P. uncias Ires et viginti. 
Sevi o villi preparati P. unciam unam. 

Tere primum hydrargyrum cum sevo et tantillo adipis suillse, donee globuli 
visum fugerint ; dein adde quod reliquum est adipis, ut fiat unguentum. 

Unguentum hydrargyri mitius. 

R. Unguentum hydrargyri fortioris partem unam. 
Adipis suillae preparatae partes duas, misce. 

No. 3. Pilule hydrargyri, -outgo, Pilulce mercuriaies. Ph. Edin. 

R. Hydrargyri. 

Manna:, utriusque unciam unam, pulveris glycyrrhizae uncias 
duas. 

Tere hydrargyrum cum manna in mortario vitreo, donee illius globuli visum 
penitus effugerint, addito prout opus fuerit, mucilagmis gummi arabici ali- 
quantulo ; dein pulverem glycyrrhizae adjicc, et aqua fiat massa, statim divi- 
denda in pilulas quadringentas octogmta aequales. 

No. 4. Solutio mercurii gummosa, vulgo. Plenk's solution, 

R. Mercurii vivi depuratissimi X i. 
Gummi Arabici J ii. 

Terantur invicem in mortareo lapideo, addito medio, cochleari aquae fumariae, 
donee mercurius penitus dispareat in mucum. Exacte subactis admisce sen- 
pirn conterendo. 

R. Syrupi kermesini 5 ss. 
Aquae fumariae 5 viiL 
Sum. mane et vespere, cochlearia duo. 

Solutio Mercurii Mia. 

R. Hydrargyr. puriss. ^ ii« 
Gummi Arabici 5 ss. 

Terantur invicem in mortareo lapideo, addito medio, cochleari aquae, donee 
hydrargyrus in mucum dispareat. Huic subacto adde. 

Aquae fontanae 5 ix. 

No. 5. Mel Mercuriale. 

R. Mellis; 

Hydrargyri, utriusque unciam. 

Terantur in mortareo marmoreo donee hydrargyri globuli non amplius appa» 
sreant 



APPENDIX. 323 

No. 6. Hydrargyrus cum creba, vulgo, Mercurius alkalisatus, 
Ph. Zond. 

R. Hydrargyri purificati uncias tres. 
Crete preparatse uncias quinque. 
Tere simul, donee globuli visnm fugerint 

No. f. Hydrargyrus calcinatus, -outgo, Mercurius calcinatus, 
Ph. Zond. 

R. Hydrargyri purificati libram unam. 

Hydrargyrum in cucurbita vitrea, cui fundus planidr sit, in 
balneo arenac caloris 600°, exporie, donee in pulverem 
rubrum concreveiit. 

No. 8. Hydrargyrus muriatus corrosivus, -vulgo', Mercurius 
sublimatus corrosivus. Ph. Ed, 

R. Hydrargyri. 

Acidinitrosi diluti, utriusque uncias quatuor 

Muriae exsiccatx, 

Ferri vitriolati exsiccati, utriusque uncias quinque, 

Solvatur hydrargyrus in acido. nitroso, et vapOret solutio in massam albam. 
pemtus siccam ; dein adde muriam et ferrum vitriolatum. Bene contrita er.' 
commixta indantur phialae, quam fere dimidiam impleant ; et ex arena, primuui 
igne leni, postea sensim aucto, sub'limentur. 

No. 9. Hydrargyrus muriatus mitis, -vulgo, Calomelas, sive 
mercurius dulcis. 

R. Hydrargyri muriati corrosivi, in mortario vitreo triti un= 
cias quatuor, 
Hydrargyri uncias tres cum semisse 

Terantur simul in mortario vitreo ad extinctionem hydrargyri ; pulvisque 
phialae oblongx, cujus tertiam tantum impleat pai'tem, inditus, ex arena calida 
sublimatur. Sublimatione peracta confractaque phiala, pulvis rubens circa 
fundumet albicans circa collum ejus pariter rejiciendus est, massa vero reliqu?, 
ter quatuorve denuo sublimando, et in pulverem tehuissimum terenda, 

No. 10. Solutio mercurii spirituosa, 

R. Mercui*. sublimat corros, gr. x, 
Solve in spirit, vin. gallic ? xvi. 

Ko. 11. Pilules e mer curio sublimat o corrosive*? 

R. Mercurii sublimati corrosivi. 

Salis ammoniaci, utriusque grana decern 

Aqux distillatx drachm am: 

Conserve rosarum scrupulos duos. 

Pulveris radicis glycyrrhizze, q- s, ut f massa in piluias 



321 APPENDIX. 

No. 12. Aqua fihagadenica. 

R. Mercurii sublimati corrosivi scrupulum unum. 
Solve in aquae calcis libram unam, 

No. 13. Hydrargyria nitratus ruber, vulgo, Mercurius fired* 
fiitatis ruber. Ph. Edin. 

R. Hydrargyri. 

Acich nitri diluti, utriusque libram imam. 

Sol vat ur hydrargyria, lentoque igne vaporet solutio in massam albam sic* 
cam ; quae in pulverem contrita, et cucurbitae vitreae inditae, torreatur igne- 
sensim aucto, materia assume bacillo vitreo agitata ut aequaliter incalescat, 
donee ejus p.-.uxdlum, cochleari vitreo exemptum et refngeratum, squamulas 
splendentes rubras exhibeat. Turn vas ab igne removeatur. 

No. 14. Unguent um Hydrargyri JVitrati, vulgo t unguentum Ci- 

trinum. 

Hydrargyri unciam unam. 
Acidi nitrosi, uncias duas. 
Axungiae porcmae libras duas. 

Digere hydrargyrum cum acido nitroso super arenam calidam, ut fiat solutio, 
quam calidissimam adhuc misce cum axunge porcma hquefacta, et denuo 
frigescente ; strenue dein misturam subige in mortar 10 vitreo, ut fiat unguen- 
tum. 

No. 15. Hydrargyrus firecipitatus cinereus, vulgo, Pulvis mer- 
curii cinereus. Ph. Edin. 

R. Hydrargyri. 

Acidi nitrosi diluti, paria pondera. 

ilisce ut solvatur hydrargyrus, solutum aqua pura dilue, et adde aquae aim 
moriise quantum satis sit ad hydrarg} rum penitus ab acido liberandum ; pulvis 
dem aqua pura lavetur et exsiccatur. 

No. 16. Hydrargyrus -vitriolatus Jlavus vulgo, Turfiethum mi- 
neralc. Ph. Lond. 

R. Hydrargyri punficati libram unam, 
Acidi vitriohci uncias quindecem. 

Mista in vase vitreo, gradatim incalescant donee co'e'ant, et materia igne acrj. 
penitus exsiccetur. Haec, plurima uqua distillata calida affusa, statim flaves- 
eel, et m pulverem fatiscet, pulverem tere cum hac aqua in mortaho vitreo. 
Po.-,iquam pulvis subsedent aquam etf unde, et aqua distillata lava matenem 
donee saporis expers fuerit; 

No. 17. Pilula e mer curio acetato, vulgo, Trochisci Keyscri. 

R. Mercurii acetati. 
Mannac puris. 

Pidv. gum. arab. utriusque ^ i. 
Aquae rosce, q. s. ut. f, massa in pilulas sexaginta dividends. 



APPENDIX. &Z& 

No. 18. Pilulce c mer curio tartarisotQ, 

H. Mercurii tartar is at, ^ i- 
Pulv. rad. glycyrrhiz. 
Conserv. rosae. utriusque £ u - 

Mucilag. gum. arab. q. s. ut f. massa in pilulas Sexaginta &?£» 
denda. 

No. 19. Gargarisina e borace. 

R. Borac. pur if. 5 i- 

Solv. ui aquae fontanae bullientis libram unam, et ad<je. 
Mellis op tun. uncias duas. 

No. 20. PiluU Plummeri, 

R. Calomelanos. 

Sulphuris aurat. antimon. utriusque uncianU 
Conserv. Rosar. q. s. ut fiat massa. 

No. 21. Decoctum ligni guaiacL 

R. Rasur. ligni guaiac. ± iss. 
Rad. glycyrrhizae T ss - 
Coq. m aq. fontanae lb. ii. ad. lb. iss, 
Colaturae adde. 
Saccari, q. s. 

No. 22. Decoctum sarsafiarilte. 

R. Radicis sarsaparillae fissae 5 hi- 
Aquae bullientis libras tres. 

Jhfundantur per horas quatuor, dein expresso liquore probe contundatur radir, 
cui iterum adjice liquorem. Macera per horas. septem, postea coque ad libra? 
duas, et fortiter exprunendo cola. 

No. 23. Decoctum rad. mezerei, 

R. Corticis radicis mezerei, drachmam. 
Radicis glycyrrhiz ae, drachmas duas. 
Aq. fontanae libras tres. 
Coque ad libras duas. 
Colaturae adde. 
Syrup, altheae unciam unam. 

£[0. 24. Pulvis ifiecacucLhhc comfiositus^ vulgo,Pulvis Dover% 
Pharm. Lo?id. 

R. Ipecacuanhze, 

Opii purificati duri, singulorum inpulverem tritorem drachmam 

unam. 
Kali vitriolati in pulverera triti unciam unam. Misce. 



326 APPENDIX. 

No. 25. Unguentum mercurials album 

R. Unguent, simplic. Ph. Edin. uncias duas. 
Calomelanos drachmas duas. Misce. 

No. '?" Unguentum mercuriale rubrum. 

R Unguent. Basilic. Pharm. Edin. unciam unam. 
Mercur. precip. rub. pptt. drachmas duas. Misce:. 

No. 27. Unguentum ex Mrugine. 

R. Unguent, basilic. Pharm. Edin. unciam unam. 
JEruginis pulv. scrupulum imam. Misce. 

No. 28. Unguentum saturninum. Pharm. Lond. 

R. Cerussae acetatae drachmas duas. 
Cerae ulbae P. uncias duas. 
Oiei olivae M. libram dimidiam. 

Cerussam acetatam, in pulverem tritam, cum aliqua olei parte contere ; deincic. 
ram Ccrce, cam oleo reliquo liquefactae, adde. Misturam agita donee refrixeriU 

No. 29. Linimentum ccr<e. Pharm. JLond. 

R. Cerae albae P. uncias quatuor. 
Spermatis ceti P. uncias tres. 
Olei olivae M. libram unam. 

Lento igne liquefacta assidue acriterque agita, donee refrixerint 

No. 30. Linimentum lafiidis calaminaris* 

R. Olei olivarum M. libram unam. 
Cerae albae P. uncias duas. 
Lapidis calaminaris praeparati, P. unciam unam. M.S. A. 

.No. 31. Emfilastrum lithargyri^ vulgo, Emfilastrum commune. 
Pharm. Edin. 

R. Lithargyri partem unam. 
Olei olivarum partes duas, 

Adjecta aqua, coque, assidue agitans, donee oleum et Lithargyrus coeam 
In emplastrum. 

No. 32. Muriated Barytes, 

This preparation is obtained by dissolving aerated barytes in the 
muriatic acid. The process is not difficult, and I meant to have 
given a form of it ; but as this article has never till of late been used 
as a medicine, as some varieties of the terra ponderosa have lately 
been discovered, and as it requires some discernment to distinguish 
ihem, I think it better, in a point of such importance, to refer to a 



APPENDIX. 327 

more particular account of it than could be inserted in this place. 
This is the more necessary, as the medicine, even in its purest 
state, is "f a nature that requires to be used with much caution ; 
and particularly as many specimens of barytes are found to contain 
considerable quantities of lead, copper, and arsenic. 

The paper to which I allude is written by Doctor Adair Crawford 
of London, and is inserted in the second volume of Medical Com- 
munications. Doctor Crawford, besides giving an accurate derail 
of the effects of this medicine in several cases of scrophula and 
cancer, gives directions for detecting the admixture of other sub- 
stances, and for regulating the doses. The dose ought at first to 
be very small, not more than four dvops for an adult, and two for 
children of eight or ten years. I have found, however, that when 
increased in a gradual manner, thirty drops maybe given to an adult, 
and repeated two or three times a day ; but as Doctor Crawford very 
properly observes, the quantity should not be farther augmented, 
after it begins to excite nausea or any disagreeable symptom. I 
even think, that in such circumstances, it should, for a few days, be 
omitted, and the dose lessened on being again entered upon. In 
the trials that I have made with it, no harm has ever been done by 
it, while in different cases of obstinate sores, proceeding from scro- 
phula, as well as other causes, it has evidently proved useful. Since 
I had occasion to mention this remedy in a former part of this work, 
I have given it in twelve different cases ; but as most of these are 
still under cure, I cannot, with propriety, give a detail of them. I 
may remark, however, in general, that the more experience I have 
had of it, the more I am pleased with it. Where no effect has been 
produced by it on the disease for which it was prescribed, it has sel- 
dom failed to excite appetite, and to improve the strength and gene- 
ral health of the patient. I therefore consider it as an important ad- 
dition to our list of tonics. Hitherto the solution which I have em- 
ployed has been procured from London ; but as I expect soon to be 
supplied with a quantity of terra ponderosa, I mean to have it pre- 
pared here. 



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EXPLANATION OF THE PLATES. 



We have added to this edition the plates of Mr. Charles Bell, il- 
iustrating the morbid anatomy of the urethra and also delineating 
the instruments which he prefers in removing strictures in the ure- 
thra. See Note to chap. 3d. sec. iv. vol. 1. p 170. Plate V. is 
taken from Mr. Whately's Essay on an improved method of treating 
strictures in the urethra, and represents the form of the bougies 
which he uses and also the manner in which he introduces his fa= 
vourite remedy, the Kali pur um, 

PLATE L 

Fig. 1. In this figure is represented a firm stricture with an irregu- 
lar ulcerated surface. The whole penis is not represented, but 
only the spongy body of the urethra, and a few inches of the 
canal. 

A A. The corpus spongiosum urethras. 

B. The urethra cut up to show the lacunse and the stricture. 

C. The part of the urethra below the stricture. 

D. Tne stricture with a peculiar reticulated surface, the effect 

of ulceration. 

E E. A callous portion of the spongy body of the urethra. The 
cells being condensed and closed, and now forming- the 
principal seat of the stricture. 

Fig. 2. This figure was taken from Mr. Hunter's work before I had 
ascertained its incorrectness. I thought that the foim of the 
spongy body at the place of stricture was a a n sequence of the 
stricture, but on examining the preparation, I find it to be a pure 
example of the stricture, by a bridle or smaii filament, as ex- 
pressed in plate II. fig. 1. B. 

A A. Corpus spongiosum urethrae. 

B B. The internal surface of the urethrae. 
C. The stricture. 

Fig. 3. In this rough etching there is represented a stricture of the 
oesophagus, to shew that the narrowing of the passage was not a 
consequence of the muscular coat contracting, but a deposition 
of coagu table lymph betwixt the inner coats: the oesophagus is 
ciu directly across at the contracted part. 

A. The muscular coat, or tunica vaginalis guiae. 

B. The thickened internal coats. 

C. Tne passage diminished, so as not to admit a crow quill. 

Fig. 4. This represents the effect produced upon the urethra, by 

a stone sticking in it. 
A A. The body of the penis, 
B B. The corpus spongiosum urethrae. 

C. The place of the urethra in which the round stone stuck. 
D D. Shreds of coaguiablc iymph which were thrown out on all 
the surface of the urethra, a sufficient proof of the violence 

VOL, II, 12 



330 EXPLANATION OF THE PLATES. 

of that inflammation, which reaching the bladder, occa 
sioned the patient's death. 



PLATE II. 

Fig. I. This plate represents a considerable portion of the urethra. 

with its surrounding spongy body and the prostate gland. 
A A. The urethra. 

B. Two filaments forming a stricture, which during life power- 

fully resisted the introduction of a large bougie. 

C. Another stricture of the same kind, behind which there is 

the appearance of a little sac into which the bougie is often 
hitched * 

D. Another little cord on the nearer side of the urethra : it will 

be observed, however, that this cord did not stand across 
the urethra, as might be imagined from the appearance 
presented here, it was like B or C ; but to demonstrate 
the firm nature of it, I cut away the membrane of the 
urethra.f 

E. Little warty excrescences, which, however, the engraver has 

but very imperfectly represented, they ought to have been 
more agminated and prominent. 

F. The ducts of the prostate gland enlarged into, great cells, 

which would very readily receive the point of the largest 
catheter. Such cavities I believe to be the source of the 
worst kind of fistula in perinaeo. 

G. The caput gallinaginis. 

Fig. 2. Represents the point of the bougie, as it often appeared 
when introduced during the patient's life. I saw the danger of 
forming a false passage in this indication of a sharp line cutting 
the point of the wax bougie. 

Fig. 3. The bougie, as it often appeared*when withdrawn from the 
urethra of the same patient. In this case the point had not enter- 
ed the proper passage, nor struck against the ligamentous fila- 
ment, but had gone betwixt the filament and the side of the ure- 
thra, so as to make a sac (c. fig. 1.) If this had been persevered 
in, a false passage would inevitably have been formed. To avoid 
this, I was careful never to allow the bougie to remain, unless 
the resistance to withdrawing it proved it to be wedged in the 
proper canal. 

* This is of the nature of the folds of the membrane of the urethra, re- 
sembling the valve of a vein which has been described by Goulard and De- 
fault. 

f After much doubt of the accuracy of my first observations regarding the 
nature of this stricture, and at last having repeated opportunities of satisfying 1 
myself, both of its existence and its very frequent occurrence, I find by turning 
my attention to Besault traite des Maladies des votes urinaires, that I might 
have saved myself any anxiety on this point, for there I find a very accurate 
description of this obstruction to the urme, 'par des brides? But he considers 
these ligamentous filaments to be an effect of ulceration, condemns the u c e oft" 
the caustic, and recommends the use of the elastic gum bougie 



EXPLANATION OF THE PLATES. 331 

The appearance of a valve is probably formed by the point of the 
bougie pressing betwixt the filament and side of the urethra. 

The kali purum was applied three times to this stricture, but no 
sloughing or erosion, or effect of any kind is apparent. 

Fig. 4. This represents the urethra slit up to show the effects of 
the lunarcaustic on stricture. 

A A. The glans penis. 

B B. The body of the penis. 

C C. The spongy body of the urethra;. 

D. The urethra behind the stricture. 

E. The stricture. 

F. Coagulable lymph accumulated behind the stricture, a certala 

proof of their having been much inflammation there, 

G. Loose shreds of a very fine membrane, where the caustic had 

been applied. It would appear from this case, that if the 
proper stricture had been destroyed, still the coagulable 
lymph accumulated behind, would have been a cause of 
obstruction to the urine. The inflammation on the part 
of the urethra behind the stricture, and on the inside of 
the bladder, produced such irritation that the patient died. 

PLATE III. 

This etching represents the effect of stricture on the bladder, 
A A. The walls of the bladder greatly thickened. 

B. Much coagulable lymph behind the stricture of the urethra,, 
and at the neck of the bladder. 

D. Membranes formed of coagulable lymph hanging from the 
inside of the bladder. 
E. E. Firmer masses of coagula attached to the inside of the bladder* 

These are sufficient indications of the degree of inflammation 
and the suffering of the patient. Disease to such an extent as this 
reduces the patient to a state of irritability that will permit nothing 
to be doneo 

PLATE IV. 

Fig. 1. The urethra cut open to shew a long contraction in it, and a 
wasting of the spongy body. 
A. The urethra anterior to the stricture. 

B C. The urethra contracted for near three inches in its extent. 
D. The urethra very dilatable behind the contraction. 

Fig. 2. Urethra sounds of different sizes : the wire is made of sil- 
ver, and of the length of a common bougie, the ball is ri vetted 
on, a perfect globe, and highly finished ; the balls ought to be of 
various sizes, from the diameter of the largest to the smallest 
bougie, but four sizes will generally be found sufficient. 

Fig. 3. The urethra sounds having the balls perforated for the lodge*- 
ment of a small portion of lunar or alkaline caustic, 

The intention of this instrument is to introduce the caustic upon 
the dilatable stricture, or to a common stricture, where the ob~ 



332 EXPLANATION OF THE PLATES. 

ject is to let a certain portion of caustic dissolve and come hi 
contact with the urethra in solution, the advantage of the ball 
probe or sound, in this case, over the bougie, as employed by 
Mr. Whately is, that we are better enabled to ascertain the place 
of the stricture, and therefore to apply the caustic more accu- 
rately. 
Fig. 4. This. is a urethra probe, where, instead of a ball, there is a 
pyriform knob; the curve given to the wire enables us to intro- 
duce it into the neck of the bladder, and I have used it with much 
advantage in allaying the irritation at the neck of the bladder; 
for this purpose I have gently introduced it along the canal, and 
then moved it several times through the further part of the canal, 

PLATE V. 

Fig. 1. Represents a bougie bent at the point, for the purpose of 
being passed through an irregular stricture. The bent point 
should be passed down the urethra on that side of it to which the 
aperture of the stricture is supposed to be situate. 

Fig. 2. Represents a bougie having the proper degree of curvature 
given to it, before it is armed with kali, in order to be passed 
through a stricture at seven inches distance from the orifice of the 
urethra. 

Fig. 3. Represents a large flexible gum catheter, with a thick iron 
wire inserted into it, and of a proper degree of curvature, in order 
to be passed into the bladder with the wire, in cases of an enlarge- 
ment of the prostate gland. 

Fig. 4. Represents a flexible gum catheter very much curved, by 
means of a small wire inserted into it, in order to give the catheter 
the degree of curvature of a common silver catheter, when the 
wire is withdrawn, in which state it is to be passed into the blad- 
der. The degree of curvature I have represented, is particularly 
necessary in new instruments, but it may be afterwards varied a 
littie, according to the stubbornness or flexibility of the instrument. 

Fig 5. Represents a bougie a size larger than one of the finest kind, 
for applying tne caustic to a very contracted stricture. 

Fig. 6. Represents a clota bougie of the very finest kind. It is gene- 
rally necessary that bougies of this slender make should be of a 
conical shape, otherwise they would not be firm enough for intro 
duction. 

Fig, 7. Represents a very fine catgut bougie. 




A. 



ABORTION a frequent consequence of Syphilis 

■ observations on - 

Abscesses inperinaeo - 

■ in the corpus cavernosum penis 

in the substance of the urethra 

Absorption, promoted by friction - » 

JErugo, form of using- in injections - 

JEther, useful in spasms of the urethra 
Alkali Volatile, forms of using in injection 
Alum, used in injections for Gonorrhoea 

> — form of using - 

and - 
Alopecia, description of 

method of treatment of 

Anomalous Symptoms, description of 

method of treatment of 

Antidote, definition of the term 

Anumony Crude, useful in venereal eruptions 
Aqua Phagadenica, form of - 

Asthma Venereal, cases of cured by mercury 
Atrophy, a symptom of Lues Venerea 

described - 

venereal, method of treatment of 



Vol 


Page, 


U. 


265 




ib. 


I. 


75 




ib. 


. 


ib. 


II. 


23 


- 


317 


L 


141 


n. 


sir 


i. 


63 


n. 


314. 




316 


- 


7S 




251 


V 


81 




254 


- 


108 




243 


- 


324 




289 


- 


83 




ib. 


•> 


255 



B. 



Balsams Astringent, used in injections , , 

their use in Gleet 

. , form of using in injection 

and 
Bark Peruvian, useful in Gonorrhoea - 

m swelling of the testis 

Barytes Muriated, its effects in sores succeeding to buboes 

. observations on the use of 

Bladder, inflammation of 
Blindness, from Lues Venerea - 

■ description of - 

venereal, method of treatment of 

Blisters, use of m Gonorrhoea - 



II 



n. 
i 



z 



useful in Gleet - 

their utility in deranged sensations of the bladder and perineum 

sometimes useful in hernia humoralis ... 

■ in certain kinds of swellings - n. 

Blood-letting, when indicated in Gonorrhoea - - L 



useful in Chordee - 

local, useful in the treatment of bubo 



IT, 



63 
116 

314 
316 

75 

205 

233 

326 

86 

77 

ib. 

251 

73 

119 

188 

205 

247 

78 

93 

225 



INDEX.. 



Blotches, venereal '- - .- • - 

most frequent seat of - - 

how distinguished - 

— — . cure of - 

Borax; its utility in removing- mercurial salivation 

Bougies __..--- 

— often useful in gleet - 

— — — observations on 

— chief objects in the formation of 

■ directions for the use of - 

■■ ■ i. " sometimes slip into the bladder 

time of remaining in the urethra ... 

should not be allowed to remain long in the bladder 

■ - much perseverance necessary in their application 

■ — formulae for preparing 1 - 
Bubo, definition of - 

may take place without chancre, or any previous mark of infection 

produced by the absorption of the syphilitic virus 

seat of ----- - 

frequently more than one 

cause of being always external - 

description of - 

■* - '■' " suppurates more quickly than other glandular tumours 

how distinguished from other tumours in the groin 

— — often connected with scrophula - 

sometimes connected with erysipelas 

— — in women, situation of 

— — at first, always local - - - . - 

method of treatment of 

suppuration of, never to be encouraged 

— — discussion of, always to be attempted 

remedies to be applied for 

• suppurated, treatment of - 

object in opening - 

different methods of opening 



Indolent, state of described 



Calces of Mercury, activity of 

differences between the 

Calammans Lapis, form of using in injection 
Calomel, used in injections in Gonorrhoea 

forms of using in injection 

— ' — observations on 

frictions with, in the inside of the mouth 

Camphor proves useful in chordee 

form of using in injection 

and 
Cantharides, useful in gleet 

— — ■ form of using in injections 

Carimcles, or fleshy excrescences in the urethra 
Cataracts, from Lues Venerea 

effect of mercury upon 

Catheter, observations on the use of the 
Caustic, danger of introducing into the u?ef3ira 



Vol. 


Page. 


II. 


50 


- 


51 




5:; 


- 


243 




171 


I. 


115 




118 


. 


151 




153 


. 


154 




157 


- 


158 




160 


. 


165 


n. 


26 


. 


26 


xtion 


21 


. 


21 




26 


- 


27 




28 


- 


29 




30 


- 


31 




ib. 


- 


32 




35 


. 


ib. 




223 


- 


ib. 




ib. 


. 


224- 


II. 


228 


. 


ib. 


. 


229 




. 233 



II. 


133 




134 




313 


1. 


62 


II. 


313 


- 


142 




146 


I. 


92 


II. 


313 


- 


316 


I. 


114 


JL 


317 


I. 


144 


II. 


77 


- 


252 


J. 


193 


- 


167 



INDEX. 



Caustic, caution, in applying to chancres 
experiment concerning - 

method of using 1 ... - 

its utility in sores succeeding to buboes 

in venereal ulcers - 

Chancre within the urethra, instance of 

the matter of does not produce Gonorrhoea 

does not always precede buboes - - 

described - - - - • 

different periods of appearing - 

seat of - - - - - - • 

matter of ----- - 

varieties of ... 

in some instances, rapid progress of - - 

■ remarkable instances of - 

1 in women - - . 

cure of - - 

should be healed speedily - 

the cure of, not always to be effected by the internal use of mercury 

never to be trusted to local remedies alone 



most quickly cured by the use of caustic 
inflamed state of, relieved by leeches 
dangerous haemorrhage from 
inflamed state of, not hurt by mercury 
clean state of various applications for 
treatment of, when conjoined with phymosis 
in women, method of treatment of 



Vol 


Page. 


11. 


210 


- 


ib. 




212 


- 


232 




237 


I. 


26 




32 


- 


215 


n. 


12 


. 


13 




ib. 


> 


14 




ib. 


. 


16 




17 


• 


ib. 




208 




ib. 


lercu 


ry ib. 


- 


209 




210 


- 


215 




216 


- 


218 




ib. 


- 


219 




ib. 




81 




254 


I. 


91 




ib. 


n. 


234 


L 


226 


- 


75 




116 


- 


206 


n. 


63 


i. 


104 




208 


_ 


209 


n. 


52 


i. 


72 



Chops in the hands and feet described - 

method of cure of 

Chordee, definition of - - 

produced by inflammation - 

Cicuta, sometimes useful in sores succeeding to buboes 
Circumcision, observations on the operation of - 
Cold Bathing, useful in Gonorrhoea 

in Gleet - 

in swelling of the testis 

Cold and Dampness, dangerous effect of in Lues Venerea 
Consequences of Gonorrhoea Virulenta - - 

Cord Spermatic, swellings of 

: remedies applied for 

Corona Veneris, what - 

Cowper's Glands, affections of - 



D. 

Deafness, from Lues Venerea - - - - II. 80 

s method of treatment of 253 

Decoctum Lustiamcum, or Lisbon diet -drink, formulae of - 320 

Ligni guaiaci, form of - - - - - 325 

Sarsaparillae ------- ib. 

Mezerei - = „..- ib. 

Deranged Sensations in the bladder and urethra - - I. 183 

, no t easily accounted for - 186 

remedies to be used in - - - - 187 

Diarrhoea excited by mercury, remedies for n. 174 

Diseases, different, may exist at the same time on the same part - 58 

Dropsy, syphilitic, case of cured by mercury - - - 304 

Duncan, Dr. his opinion of the action of mercury - - 112 



Vol. 


Page. 


II. 


234 




81 


I. 


204 


II. 


321 


- 


326 


- 


307 


. 


177 


- 


ib. 


- 


210 


I. 


27 


- 


222 


n. 


70 




ib. 


- 


71 


- 


247 



INDEX. 



Electricity, its utility in the indolent state of Bubo 
Elephantiasis, a symptom in Syphilis - 

Emetics, their utility in Hernia Humoralis - 
Emplastrum Mercuriale, form of 

Lithargyri, form of - 

Epilepsy Syphilitic, case of, cured by mercury 
Eruption induced by mercury, description of 

remedies for 

Escharotics, their utility in chancres - - - 

Excoriations from Gonorrhoea do not require mercury 

> in the parts of generation of women 

Excrescences Venereal, about the anus ... 

■ — description of - 

*— - =► — — in women, sometimes produce buboes 

cure of - * 



F. 

Fever, as a symptom of Lues Venerea II. 84 

— — Venereal, observations on - 257 

Fistula in Perinxo, most frequent cause of - - - I. 166 

Fluor Albus, its resemblance to Gonorrhoea ... 95 

— how to be distinguished from Gonorrhoea 97 

. cured by astringent injections - ib. 

Frenum, sometimes necessary to cut II. 214 

Fumigations with Mercury, in what manner applied - - 137 

— — — — i sometimes useful in chancres -> 214 

~ t]ieir utility in sores succeeding to Buboes - 232 



G. 

Gangrene induced by Chancres, rapid progress of •> H. 215 

« ■ opium the best remedy for - 216 

mercury does harm in - 217 

325 
270 
I. 214 
215 
217 
105 
107 
108 
- • ib. 
110 
111 
114 
116 



Gargansma e borace, form of 
Gilchrist, Doctor, his Essay on Sibbens 
Glands in the Grom, swell.ngs of 

»■■ remedies employed in 

Glaus and Prepuce, excoriations of - 
Gleet, import of the term 

remarkable case of - 

. arises from different causes 

. often the effect of local relaxation 

seldom of general debility 

remedies useful in 

inflammation useful in 

diet recommended in 

relieved by a seton in perinaeo - 120 

■ a frequent consequence of strictures in the urethra - * ib. 

— — sometimes relieved by opiates .... 123 

Gonorrhoea and Lues Venerea appeared at different periods : - 18 

r- a much more frequent disease, than pox - - 26 



INDEX. 

Vol. Page 

Gonorrhoea translation of the matter of - > - » I. 28 

— the matter of, does not produce chancres - 32 

— and syphilis sometimes remain long distinct - - 33 

— time of appearing- ----- 37 

— symptoms of - - - - ; - - 38 

— sympathetic pains in 39 

— in women ------ 41 

matter of ----- - 42 

— manner of infection in 43 

— remarkable fact in - . - - 44 

— matter of, not produced by ulcers - 45 

— produced by inflammation - 46 
■ — resemblance of to catarrh - - - - 47 

— prognosis in ----- 48 

— general observations on the cure of 50 

— first stage of - 57 
— . regimen in ------ 68 

— low diet improper in. - .--,,- ..'..» ib. 

— second stage of - - - - - ^ TO 

— third stage of - 77 
— - fourth stage of 85 

— in women --._.. 95 

— always a local disease- - 99 
Gonorrhoea spuria, what - 217 

— observations on - 218 

— means of distinguishing from Lues Venerea 219 
~ method of curing ... 220 

— excited by savine applied to the urethra - 235 
Gonorrhoea simplex - - - - - - 236 

— observations on ib. 
*— remarkable case of 237 

— may be produced by the matter of fluor albus 239 

— may excite swelling of the testis - - 241 

— — swellings of the inguinal glands ib, 

— necessity of discriminating - 242 

— method of cure - - ib 
Guaiacum, observations on - - - 11= 192 

— proofs of its power as an anti-syphilitic - - 193 
Gutta Serena, from Lues Venerea - 7? 

H. 

Haemorrhages from the urethra -.,.-•- 

— produced by chancres, remedies for 

Headach, syphilitic case of, cured by mercury 
Hernia Humoralis, what - 

— femoralis, sometimes mistaken for bubo 
Herpes, similar to Venereal eruptions - 
Hunter Mr. John, some of his opinions examined, Vol. II, page; 

103. & 175 
Hydrocele, sometimes induced by hernia humoralis 
Hyoscyamus, proves useful in chprdee 

T» 

Impotency, what , * » « I. 126 

— — ' causes of \« - ..■» - * IK 

vol, ii, 43 



I. 


94 


II. 


216 




305 


i 


194 


II, 


33 




53 


23. 


58. 92. 


I, 


199 




P. 



IIxDEX, 



tmpotency frequently induced by local weakness 
— seldom the effect of general debility 

two stages of - 

« first stage of 

second stage of - - - 

relieved by electricity - 

by hyoscyamus 

„ ma y occur from swelling of the epidydymis 

J: flammation, slight degree of, necessary for the production of bubo II. 
Injections, their early application recommended 

< not to be used while the testes are swelled 

strength of 

« ■ — manner of using » - - 

■ frequency of using , - - - 

sometimes do harm .... 

- general observations on the use of - 

. ■■ ' stimulating, useful in gleet - 

astringent sometimes useful in gleet 



Vol. 


Page. 


I. 


127 




128 




190 


- 


130 




132 


- 


134 




ib. 


- 


197 


II. 


23 


I. 


59 


, 


61 




64 


- 


65 




66 


- 


75 




102 


, 


ib„ 




118 


n. 


313 



lormulse of 



K. 

Kidneys sometimes affected in Gonorrhoea - I. 47 

Kino, an useful ingredient in injections - 63 

useful in haemorrhagies - - - - - - 94 

forms of using in injection - - - -II. 314 

. its utility La Diarrhoea - - - - - 175 



L. 

Lapis Calaminaris used in injections - -.. - I. 62 

L ider, spirit oi, an application for chancres - - II. 218 

Le L, Lsed in i jections I. 63 

Leeehes, .ueir utility in hernia humoralis - 198 

their bites, observations on - 221 

Lime Water, when useful in gleet - 122 

Lmnnentum Cerae, form of II. 326 

Lips, method of treating chancres on - ... 220 

Lixivium Causticum, form of usmg in injections, - 317 

Lues Venerea, sometimes takes place Without chancres - I. 24 

appeared in Europe before Gonorrhoea - 33 

— appeared at OUheite before Gonorrhoea - - ib. 

■ when first accurately described - -II. 7 

in what manner communicaced 8 

■ — often given by an infected nurse to a child, and vice versa ib. 

may be communicated by the milk in nursing - 9 

■ ■ — matter of, may be absorbed from any part of the sur- 
face of the body - ib„ 

• matter of, is not readily absorbed from the stomach 10 

■ symptoms of 12 

the cause of its breaking out sooner in some than in others 25 

< cannot be cured by evacuants - - - 107 

— in infants ----.. 257 

— proofs of -»«.„* 259. 

— ., =™_ . cases of - . , :■ . - * ■- - * ib-, 



INbE^c 



Lues Venerea, how to be treated 

. ■ — remarkable case of - 

— some peculiarities of form of 

— — its power m inducing- other diseases 

Lymphatic vessels of the penis, swellings of 

— — — remedies useful in 

— — — two cases of 
Lithargyri acetum s form of 



Vol Page,. 



- II. 



II. 



263 
266 
268 
284 
210 
213 
ib. 
315 



M. 



Mania Syphilitic, case of, cured by mercury- 
Mel Mercuriale, form of - 
Mercury not necessary in Gonorrhoea 

! useful in a thickened state of the bladder 

— — never proves useful in gleet - 

apt to do harm in hernia humoralis - 

crude, form of using in injection 

Mercunus sublimatus cotrosivus, form of using in injection 
Mercury, partial use of, a remarkable effect of 

■ general observations on - 

— — general effects of on the system 

— — stimulating effects of - 

f distressful symptoms induced by - 

■ — operation of in the cure of syphilis - 

— u'ritation excited by, not necessary in the cure 

— does not cure syphilis by the evacuation which it excites 

— antidotal powers of, proofs of - 

— acts as an antidote in the cure of syphilis 
— . preparations of - - - 

— in what manner rendered active - 

— different methods of exhibiting- - 

— fumes of - 

— — in some cases an useful remedy 
Mercurial preparations from triture, observations on - 
Mercurius alkalisatus, observations on 

— ■ calcinatus, observations on - 

— — form of - 

— sublimatus corrosivus observations on = 

— — form of - 

— cinereus, observations on 

— — form of - 

— acetatus, observations on - 
Mercurial frictions, observations on . - 
Mercury absorbed, quantity of difficult to ascertain 
Mercurial course, duration of - - - ' - - 
Mercury alterative, course of described 

— observations on - - 

— ■ > — » not to be depended on for the cure 

syphilis 

— quantity of necessary to be employed 

— course of regimen to be observed in - 

— patients taking, ought not to go abroad 

— course of, a caution previous to - 

■ — how far to be considered as a certain cure for syphilis 

— course of, its failure m the cure of syphilis 

<— how to be applied for the discussion of buboes 



II. 309 


322 


I. 102 


103 


124 


2o4 


II. 313 


316 


59 


99 


100 


ib. 


101 


102 


103 


106 


108 


110 


130 


131 


137 


ib. 


ib. 


139 


140 


ib.. 


323 


141 


323 


143 


324 


143 


144 


145 


152 


153 


154 


of 


155 


157 


167 


168 


173 


188 


192 


-' ' 99 -i 



Vol 


Page. 


II. 


227 


- 


323 


- 


ib. 


. 


324 


, 


198 


. 


199 


I. 


204 


n. 


177 


- 


51 



INDEX, 



Mercury should "be given irr every stage of bubo 

— Van Swieten's solution of 
Mercurius dulcis, form of 

prazcipitatus ruber, form of 

Mezereon, observations on 

— method of exhibiting 

— useful in hernia humoralis 

Morbid state of the system induced by mercury 
Mucus, attraction between and mercury 



N. 

!N*odes, definition of ----- H. 62 

— most frequent situation of - - -"'.'- 63 

— description of - 64 

— cause of their being painful ib. 

— cure of------- 244 

— when they ought to be laid open - 246 



o. 

Obstructions in the urethra ^ » . - - I. 134 

spasmodic of the urethra - 137 

Ointment mercurial, strength of - - - -II. 147 

observations on the use of - - - 148 

absorption of, promoted by friction - - 149 

Onanism, the baneful effects of I. 129 

Opiate Clysters useful in Gonorrhoea - 79 

Opiate Clysters useful in Gleet ..... 123 

Opiates useful in chordee ----„. 92 

— their utility in mortification ... . 137 
Opium used in injections in Gonorrhoea - - - 63 

— proves hurtful in impotency ..... 133 

— its utility in spasms of the urethra ... 141 

— an useful remedy in swelling of the testis ... 200 

— forms of using in injection - - - - II. 314 

— its utility in removing salivation - - - - 171 

— observations on ...... cjqI 

i — when first employed in the cure- of syphilis - •* ib^ 

— proves chiefly useful by allaying irritation ... 202 
i — large doses of given in Lues Venerea ... 203 

— external application of - - - - - ib. 

— its utility in irritability of the bladder and urethra - I. 183 

— in sores succeeding to buboes - - - - n. 232 
f — often particularly useful in venereal ulcers - - 242 



Pains, venereal, how distinguished from rheumatism 
Paraphymosis, what .... 

— — observations on 

operation for - 

Phthisis Venereal', case of, cured by mercury 



ft 


6? 


1 


218 




228 




229 


i. 


2$d 



Vol 


Page- 


■f> I. 


218 


- 


223 


• 


ib. 


- 


227 


II. 


323 


. 


325 


. 


172 


• 


243 


• 


322 


II. 


320 


I. 


31 


II. 


265 


,» « 


282 


I. 


77 


II. 


325 



INDEX. 



Fhymosis, what = 

— observations on • 

— remedies employed in 

— operation for described 
Pilulae e Mercurio Sublimato Corrosivo 

— Plummeri - 

constitution in which they prove useful 

■■ their utility in venereal blotches 

Plenk's solution, form of -v 

Powders Escharotic, formula of * 

Pox, no stage of ever induces Gonorrhoea 

Pregnancy, not always an objection to the use of mercury 

Prophylactics, observations on - 

Prostate Gland, affections of 

Pulvis Doveri, form of - 



R. 

Remedies used in Lues Venerea, general observations on * II. 98 

Resina Elastica, the best material for bougies, = - - I, 153 

Rheumatism Syphilitic, case of, cured by mercury - II. 294 

Ring Worm, what ... • 53 

Routine of practice to be guarded against - 130 



Saccharum Satumi, form of using in injections 
Sal Ammoniac, form of using in injections 
Salivation not necessary for the cure of syphilis 

— method of preventing . 

— method of removing - 

— m»st effectually relieved by local applications 

— not always increased by more mercury 
Sarsaparilla, observations on - 

— method of exhibiting - 
Savine, its influence in removing warts - 
Scrcphula, observations on 

Scrotum, thickening of 

Scurvy, observations on . 

— and a course of mercury induce similar effects 
Sea Bathing useful in certain stages of bubo 

— its utility in venereal swellings of the testis 
Semicupium proves useful in deranged sensations of the bladder 
Sibbens, what - • - 

— description of - 

— method of cure of 

— method of preventing = 
Sinuses in perinseo, how to be treated - 

— - produced by buboes, distressful effects of 
Solutions Escharotic, formulae of 

$ore Throat, venereal =-..-. 
— - description of -,..-.- 

— often accompanied with erysypilas 

— sometimes productive of deafness 

— sometimes penetrates to the bones 

— sometimes mistaken for otte affections. 



It 


315 


. 


316 




169 


a 


ib. 




170 


. 


ib. 




171 


- 


196 




197 


I. 


234 


II. 


191 


- 


82 




189 


* 


191 




234 


- 


250 


I. 


188 


IL 


268 




ib„ 


. 


272 




273 


I. 


76 


II. 


230 


. 


320 




37 


= 


ib 




38 


- 


39 




40 


* 


41 



NBEX. 



Spasms of the urethra relieved by blood-letting 

— by blisters o • 

— by electricity 

— by bougies 

Strictures in the urethra, observations on *, 

— seldom the consequence of ulceration 

— — nor of the rupture of blood-vessels - ' 

— — nor of the use of injections 

— most frequently induced by relaxation 

— not to be cured by mercury ... 

— cured with most certainty by bougies 
Sweating induced by mercury, method of preventing 
Symptoms, from the sudden stoppage of Gonorrhoea not venereal 
Syphilis, remarkable cure of * " - .; * 



Vol. 


Page 


I. 


141 


- 


142 




ib 


- 


143 




146 




148 




ib. 


. 


149 




150 


. 


151 




ib 


11. 


176 


I. 


23 


II. 


173 



T. 



Tendons and ligaments not often affected in Lues Venerea 
Testicle, swelling of, from Lues Venerea - 

— difference between it and hernia humoralis 

— how distinguished from sarcocele 
Testes, both, sometimes swell in Gonorrhoea 

— swelled, symptoms produced by 

— sometimes swell from sympathy 

— swelling of, most frequently the effect of inflammation 

— — seldom end in suppuration 

— remedies employed for removing - 

— decay of ----- 

— — induced by onanism - 

— — stopped by a blister applied over the scrotum 
Throat, ulcers in, cured by caustic 

Trochisci Keyseri, form of - 

Tumours in the substance of the urethra 
Turpethum Mmerale, observations on 



_ 


72 




73 


. 


74 


i 


194 


. 


ib. 




196 


. 


195 




197 


. 


198 




205 


. 


206 




ib. 


ii. 


237 


. 


324 


i. 


135 


ii. 


143 



U. and V. 



Vas Deferens, swellings of the = 

Venereal swelled testicle, cure of - - - 

Verdigris, useful in Gleet ----- 

— an useful application in chancres 
Vinegar, steams of, useful in swellings of the testis 
Virus Venereal, observations on - 

— first acts upon the fluids 

— its action in inducing other diseases 

— may remain long latent ... 

— not to be removed by an alterative course of mercury 
Vitriol used in injections - - - - - 
Vitriolum Album, form of using in injections 
Ulcers Venereal, old, when they do not readily produce bubo 

— distinguishable into two kinds 

— description of in the nose and mouth 
— in the mouth, how distinguished from other affections 
e*i venereal, some parts of the body more liable to than others 

**-* rise and progress of 



I. 


22 


II. 


248 


I. 


114 


II. 


218 


I. 


201 


II. 


86 


- 


88 




284 


o 


312 


ry 


ib. 


I. 


64 


II. 


315 


- 


23 




24 


- 


■ 42 




45 




55 


*. 


56 



INDEX, 



Vol Page. 

Ulcers Venereal, peculiar appearance of the matter of - EL 56 

— ordinary seat of ----- 57 

— succeeding" to buboes described - 6X 

— v a frequent cause of their obstinacy - 62 

— venereal, cure of - 236 

— frequent cause of difficulty in curing* - 239 
Unguentum e Calce Zinci. form of ... . «, 321 

— lapide calaminari - ib. 

— mercuriale, form of - - - - - 322 

— citrinum ----.. 324 

— mercuriale album - = . - . 326 

— — rubrum - - - - ib. 

— exiErugine --.-.. ib. 

— saturninum ---... ib. 
Urine, remarkable effect of in gangrene - 215 
Uva Ursi, its utility in Gonorrhoea - - - ' I. 89 

— in affections of the bladder - » - . 103 



Warts on the genitals , 

— observations on - 

— produced by irritation ... 

— sometimes the consequence of syphilis 

— — more frequently of Gonorrhoea 

— removed by escharotics 

— — by stimulants - 
Weeping eye, how produced by ulcers in the nose 
Women not so susceptible of Gonorrhoea as men 

<=— not liable to strictures in the urethra 



FX!S T IS, 



I. 


232 




231 




232 




ib. 




ib. 




234 




ib. 


II. 


44 


I. 


95 




125 



